Department of Oncology, Wroclaw Medical University, Wroclaw, Poland.
Cancer Epidemiol. 2011 Dec;35(6):e111-5. doi: 10.1016/j.canep.2011.01.011. Epub 2011 Aug 15.
To achieve a reduction in breast cancer mortality in Poland a nation-wide population-based screening was introduced in 2007.
To assess the quality of breast cancer screening programme during the first round of operation in Lower Silesia-a region of over 3 million inhabitants.
Women aged 50-69 are invited for screening, with the exception of those undergoing treatment or being followed up after treatment for breast cancer. Biennial two-view screen-film mammography is used as the standard screening test. Quality evaluation was carried out via early performance indicators. These parameters were calculated according to European Guidelines and compared with recommended levels.
Only 40% of women from the eligible population were screened. Among programme attendees the technical recall rate (a repeat mammogram because of technical inadequacy of the screening mammogram) was 0.27%. Further assessment rate (additional diagnostic techniques, either non-invasive or invasive, performed for medical reasons in order to clarify the nature of a perceived abnormality detected at the screening mammography) was 6.2%, while the short-term recall rate (early re-screen mammography at an interval less than the routine round length of the programme) was 2.4%. Cancer detection rate was 6.6/1000 while cancer detection rate expressed as a multiple of the expected breast cancer incidence rate was 3.8. Positive predictive values of the screening test and the further assessment were 11% and 77%, respectively.
The general assessment using early indicators reveals that diagnostic service conforms to the European standards on an acceptable or even desirable level. The only exception among these parameters is a too high short-term recall rate, which should be drastically decreased during the next rounds to improve the cost-effectiveness. The main disadvantage of the screening programme at its start is a dramatically poor coverage of the eligible population. If the invitation policy is not significantly intensified the breast cancer mortality rate will not be reduced, despite the good quality of diagnostic service.
为了降低波兰的乳腺癌死亡率，2007 年在全国范围内开展了一项基于人群的筛查。
评估下西里西亚地区（拥有超过 300 万居民的地区）首轮运营期间乳腺癌筛查计划的质量。
邀请年龄在 50-69 岁的女性进行筛查，但正在接受乳腺癌治疗或治疗后随访的女性除外。每年两次的双视图屏片乳腺 X 线摄影被用作标准筛查测试。通过早期绩效指标进行质量评估。这些参数是根据欧洲指南计算的，并与推荐水平进行了比较。
合格人群中只有 40%的女性接受了筛查。在参加该计划的女性中，技术召回率（因筛查乳腺 X 线摄影技术不足而需要重复进行乳腺 X 线摄影）为 0.27%。进一步评估率（为了明确筛查乳腺 X 线摄影检测到的可疑异常的性质而因医学原因进行的额外诊断技术，无论是非侵入性还是侵入性）为 6.2%，而短期召回率（在计划常规轮次长度内提前进行的早期重新筛查乳腺 X 线摄影）为 2.4%。癌症检出率为 6.6/1000，而以预期乳腺癌发病率的倍数表示的癌症检出率为 3.8。筛查试验和进一步评估的阳性预测值分别为 11%和 77%。
使用早期指标进行的总体评估表明，诊断服务符合欧洲标准，处于可接受甚至理想的水平。这些参数中唯一的例外是短期召回率过高，在下几轮中应大幅降低，以提高成本效益。该筛查计划启动时的主要劣势是合格人群的覆盖率极低。如果邀请政策没有显著加强，尽管诊断服务质量良好，乳腺癌死亡率也不会降低。
