Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
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Advances in Clinical and Experimental Medicine

2008, vol. 17, nr 6, November-December, p. 661–666

Publication type: original article

Language: English

Diagnostic Service Effectiveness During the First Year of Breast Cancer Screening in the Region of Lower Silesia

Jakość diagnostyki raka piersi w pierwszym roku badań przesiewowych na Dolnym Śląsku

Bartłomiej Szynglarewicz1,, Rafał Matkowski1,2,, Piotr Kasprzak3,, Małgorzata Strychalska3,, Piotr Kupczak3,, Jolanta Kotowska4,, Józef Forgacz1,, Marek Pudełko1,, Jan Kornafel2,

1 2nd Department of Surgical Oncology, Lower Silesian Oncology Center, Wrocław, Poland

2 Silesian Piasts University of Medicine in Wrocław, Chair of Oncology and Department of Gynecological Oncology, Poland

3 Breast Imaging and Minimal−Invasive Biopsy Unit, Lower Silesian Oncology Center, Wrocław, Poland

4 Regional Coordinating Center for Screening Programs, Wrocław, Poland

Abstract

Background. The Polish Government and the National Health Fund introduced population−based breast cancer screening in 2007 aimed to reduce breast cancer mortality.
Objectives. To evaluate the diagnostic quality of the program during its initial year in the region of Lower Silesia.
Material and Methods. This nation−wide program targets women aged 50–69, excluding females undergoing treatment or being followed up due to breast cancer. Biennial two−view screen−film mammography is used as the standard screening test. A significant reduction in breast cancer mortality requires measurement of long−term screening. Some early performance indicators are therefore widely used and accepted in monitoring the effectiveness of a screening program. These parameters were calculated and compared with those recommended by the European Union.
Results. In 2007, 79,143 women were screened in the region of Lower Silesia. Only 0.26% of them were re−examined for technical reasons. The recall for reassessment, short−term recall, and invasive examination rates were 6.85, 0.91, and 0.39%, respectively. Pathologically confirmed breast cancer was found in 460 women, giving a detection rate 5.8/1000. The ratio of cancer detection rate to expected incidence was 3.54. There were only 17 (3.7%) ductal carcinoma in situ found among all the cancers. Three hundred twenty−five cancers were histologically verified by open biopsy, giving a non−operative biopsy rate for malignancy as low as 29%.
Conclusion. The effectiveness of the diagnostic service for cancer detection during the initial phase of the breast cancer screening program corresponds to the parameters specified by the European guidelines for quality assessment of initial screening examinations. The main disadvantage is the rate of minimal−invasive biopsy for malignancy, one third of that recommended. Another challenge is the low incidence of DCIS. This needs to be carefully evaluated in the future together with the time interval and false−negative cancers. Acceptable but not ideal rates of recall for reassessment and short−term recall should be decreased in the coming years and kept at the lowest possible levels thereafter.

Streszczenie

Wprowadzenie. Wcelu obniżenia śmiertelności na raka piersi rząd RP i Narodowy Fundusz Zdrowia wprowadziły od 2007 roku populacyjny program badań przesiewowych (skryning) tego nowotworu.
Cel pracy. Ocena jakości prowadzonej w programie skryningowym diagnostyki na Dolnym Śląsku podczas pierwszego roku jego działania.
Materiał i metody. Program jest adresowany do kobiet w wieku 50–69 lat, które nie chorowały na raka piersi. Testem skryningowym jest mammografia rentgenowska wykonywana w dwóch projekcjach co dwa lata. Znamienne zmniejszenie śmiertelności na raka piersi można ocenić dopiero po kilkunastu latach trwania skryningu. Dlatego wprowadzono określone wskaźniki będące wczesnymi wykładnikami skuteczności programu i służące do monitorowania jego jakości. W pracy dokonano oceny tych parametrów w aspekcie rekomendacji Unii Europejskiej.
Wyniki. W 2007 roku na Dolnym Śląsku 79 143 kobiety wzięły udział w programie. 0,26% z nich poddano badaniu powtórnemu z przyczyn technicznych. Odsetek wezwań powtórnych celem oceny radiologicznej, odsetek kontroli przyspieszonej (w terminie krótszym niż interwał skryningu) i odsetek kobiet poddanych diagnostyce inwazyjnej wyniosły odpowiednio: 6,85; 0,91 i 0,39%. Potwierdzonego histologicznie raka piersi wykryto u czterystu sześćdziesięciu kobiet, co daje współczynnik wykrywalności 5,8 na 1000. Iloraz współczynnika wykrywalności do oczekiwanego współczynnika zapadalności wyniósł 3,54. Wśród tych nowotworów tylko siedemnaście (3,7%) było rakiem wewnątrzprzewodowym. Trzysta dwadzieścia pięć raków zostało zweryfikowanych w biopsji otwartej. Wwyniku tego odsetek raków rozpoznanych za pomocą technik minimalnie inwazyjnych był mały, ponieważ wynosił zaledwie 29%.
Wnioski. Skuteczność diagnostyki prowadzonej w pierwszym roku skryningu mammograficznego w odniesieniu do wykrywalności raka piersi była na wysokim poziomie, osiągając wyszczególnione w rekomendacjach europejskich wartości zalecane. Głównym czynnikiem obniżającym jakość diagnostyki był ponad 3−krotnie za mały odsetek raków wykrytych metodami minimalnie inwazyjnymi. Częstość wykrywania raków wewnątrzprzewodowych była stosunkowo niewielka, co wymaga dokładnej analizy w przyszłości, także w aspekcie występowania raków interwałowych i błędnie ujemnych. Odsetek wezwań powtórnych w celu oceny radiologicznej i odsetek kobiet skierowanych do przyspieszonych badań kontrolnych były na poziomie dopuszczalnym. Muszą zostać zmniejszone i utrzymane na jak najniższym poziomie w następnych latach prowadzenia programu, aby osiągnąć zalecane wartości.

Key words

breast cancer, screening program, mammography

Słowa kluczowe

rak piersi, skryning, mammografia

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