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Based on the results of the 2 pilot mammographic screening projects in Nijmegen and Utrecht, a population- based programme was set up in the Netherlands in 1989. The main characteristics of the programme are the centralised organisation including centralised technical and medical quality control and audit, the 2-year interval between examinations, and the eligible age of 50-74. The National Expert and Training Centre in Nijmegen is responsible for the technical and medical quality control and the National Evaluation Team in Rotterdam for the data collection evaluation and annual reporting of the performance results. After 15 years, the Dutch breast cancer screening programme can be regarded as an effective health care intervention at reasonable costs. A new challenge for the Dutch screening programme is the planed transformation of analogue to digital screening within the next 2 years. It will be a major logistic operation with many, at this moment still unforeseen obstacles.

Performance of a computer aided detection (CAD) system for masses in mammograms was investigated. Using data collected in an observer study, in which experienced screening radiologists read a series of 500 screening mammograms without CAD, performance of radiologists was compared to the standalone performance of the CAD system. Due to a larger number of FPs (false positives), the performance of CAD was lower than that of the readers. However, when analysis was restricted to mammographic regions identified by the radiologists, it was found that the CAD system was comparable to the readers in discriminating these regions in cancer and non-cancer. In a retrospective analysis, the effect of independent combination of reader scores with CAD was compared to independent combination of scores of two radiologists. No significant difference was found between the results of these two methods. Both methods improved single reading results significantly.

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