Faux A M, Lawrence G M, Wheaton M E, Wallis M G, Jeffery C L, Griffiths R K
West Midlands Cancer Intelligence Unit, University of Birmingham.
J Med Screen. 1998;5(2):88-91. doi: 10.1136/jms.5.2.88.
The NHS breast screening programme (NHSBSP) was established in 1987 to screen women aged 50-64 every three years to achieve a significant reduction in breast cancer mortality. Ensuring that women are re-invited every three years (that is, a three year screening round is in operation) is becoming increasingly difficult as pressure on the service rises. Coverage measures the proportion of eligible women receiving a screen in the previous three years and is currently used as an NHS performance indicator, while uptake measures the proportion of invited women who attend for screening. Data for 1996/1997 for the West Midlands NHSBSP show that, although uptake among 50-64 year olds was in excess of the 70% target at 78%, coverage was 10% below this at 68%. The discrepancy between coverage and uptake is likely to in part reflect "round slippage" in which women are re-invited at three years or more from their previous screen. To investigate the extent to which slippage is occurring in the region a technique for assessing round length independently of coverage was developed.
Records for women receiving routine recall (incident) screens between 1994 and 1997 in the West Midlands NHSBSP were examined and the time between the most recent screen and the previous screen measured in months.
Of 73,785 women screened in 1996/1997, 46.3% had a round length of under three years, although 74.9% had been re-screened within 38 months of the previous screen. Overall the regional programme was estimated to have a round slippage of approximately two months.
The West Midlands NHSBSP operates to high standards in terms of uptake and cancer detection, but round slippage must be reduced. The lack of quantitative data with which to assess round length has hindered assessment in the past. The simple technique developed in this study will allow assessment of round length to be used routinely as the key quality assurance measure for the programme.
英国国家医疗服务体系乳腺筛查项目（NHSBSP）于1987年设立，目的是每三年对年龄在50至64岁的女性进行筛查，以大幅降低乳腺癌死亡率。随着服务压力上升，确保女性每三年被重新邀请（即每三年进行一轮筛查）变得越来越困难。覆盖率衡量的是在前三年接受筛查的符合条件女性的比例，目前被用作英国国家医疗服务体系的一项绩效指标，而接受率衡量的是被邀请参加筛查的女性的比例。西米德兰兹郡NHSBSP 1996/1997年的数据显示，尽管50至64岁女性的接受率超过了70%的目标，达到了78%，但覆盖率比该目标低10%，为68%。覆盖率和接受率之间的差异可能部分反映了“轮次延误”，即女性在距离上次筛查三年或更长时间后被重新邀请。为了调查该地区轮次延误的发生程度，开发了一种独立于覆盖率来评估轮次时长的技术。
检查了西米德兰兹郡NHSBSP在1994年至1997年期间接受常规召回（初次）筛查的女性记录，并以月为单位测量了最近一次筛查与上次筛查之间的时间。
在1996/1997年接受筛查的73785名女性中，46.3%的轮次时长不到三年，尽管74.9%的女性在上次筛查后的38个月内接受了再次筛查。总体而言，该地区项目估计轮次延误约两个月。
西米德兰兹郡NHSBSP在接受率和癌症检测方面达到了高标准，但必须减少轮次延误。过去，缺乏用于评估轮次时长的定量数据阻碍了评估工作。本研究中开发的简单技术将使轮次时长评估能够作为该项目的关键质量保证措施常规使用。
