Gerard K, Brown J, Johnston K
School of Health Sciences, Department of Epidemiology and Public Health, University of Newcastle upon Tyne, United Kingdom.
J Med Screen. 1997;4(1):10-5. doi: 10.1177/096914139700400105.
To compare the UK breast screening programme with the Forrest Report recommendations of 1986.
The UK breast screening programme.
A postal survey of 97 local breast screening programmes in the United Kingdom. The main outcome measures were the frequency of screening, the use of two view screening on incident screens, reading of screening mammograms, assessment procedures and visits, staffing levels, and the use of building and equipment.
Eighty two (85%) of the questionnaires were completed and returned. All programmes screen every three years, as Forrest intended, with the exception of one health region which screens more often. The national policy is to use two views on incident screens where there is a clinical indication. None the less, 14% of programmes are using, or intending to use, two views on all women. Double reading of mammograms is not recommended in the United Kingdom outside Scotland, but is used by 88% of programmes. All programmes have access to the equipment required for the assessment techniques recommended by Forrest. Variation exists between programmes in the procedures women can expect to receive at their initial assessment visit and in the total number of assessment visits. Sixty eight per cent of programmes' breast screening budgets cover the staff required for a multidisciplinary team as defined by the Forrest Report. Ninety three per cent of screening programmes are organised around static sites, with 86% of these also using mobile vans.
The national programme is following recommendations about the frequency of screening, but there seems to be some divergence from policy as regards the use of double reading, two views at incident screening, and the multidisciplinary team covered by the programmes' breast screening budget. Further research is needed on the effectiveness and cost effectiveness of two view incidence screening, double reading, and non-radiologists as readers. Investigation is also needed of the costs and effects of the variation between programmes in the number of assessment visits a woman may have.
将英国乳腺癌筛查项目与1986年《福里斯特报告》的建议进行比较。
英国乳腺癌筛查项目。
对英国97个地方乳腺癌筛查项目进行邮寄调查。主要结局指标包括筛查频率、初筛时双侧乳腺钼靶检查的使用情况、乳腺钼靶片的阅片情况、评估程序及就诊情况、人员配备水平以及房屋和设备的使用情况。
82份（85%）问卷填写并返还。除一个筛查更频繁的健康区域外，所有项目均按福里斯特的设想每三年进行一次筛查。国家政策是在有临床指征时对初筛采用双侧乳腺钼靶检查。尽管如此，14%的项目对所有女性都采用或打算采用双侧乳腺钼靶检查。在苏格兰以外的英国地区，不建议对乳腺钼靶片进行双人阅片，但88%的项目采用了双人阅片。所有项目都能获得福里斯特推荐的评估技术所需的设备。不同项目在女性初诊时可能接受的程序以及评估就诊的总数方面存在差异。68%的项目乳腺癌筛查预算涵盖了《福里斯特报告》定义的多学科团队所需的人员。93%的筛查项目围绕固定场所组织，其中86%还使用流动车。
国家项目遵循了关于筛查频率的建议，但在双人阅片、初筛时双侧乳腺钼靶检查的使用以及项目乳腺癌筛查预算所涵盖的多学科团队方面，似乎与政策存在一些偏差。需要进一步研究双侧乳腺钼靶初筛、双人阅片以及非放射科医生阅片的有效性和成本效益。还需要调查不同项目女性评估就诊次数差异的成本和影响。
