The Dutch Population-Based Mammography Screening: 30-Year Experience

Abstract

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.

A remarkable reduction of breast cancer deaths in screened versus unscreened women: a case-referent study

“…At this moment, more regions in the Netherlands are being included in a multi-region study to support our findings in the IKL-region. Thanks to the well-organized centralized and medically audited screening program, we expect similar results in these regions [2].…”

“…It could result from the high-quality screening in a centrally organized program [2]. A second reason could be improvements due to progression in quality assurance and advancements in mammographic techniques.…”

“…As a consequence, many countries initiated a national or regional service screening program. In the Netherlands, a population-based program was set up in 1989 with a centralized organization, including centralized technical and medical quality control, and audit [2].…”

Advantages and Disadvantages of Mammography Screening

“…Also, early and less aggressive cancers that might be suspected to correspond with possible overdiagnosis do not require chemotherapy or axillary dissection. Finally, mastectomies are today only performed for extended DCIS which in general represent a significantly higher risk of developing into invasive (and sometimes extended) invasive breast cancers [45]. The same publication points out that aggressiveness of treatment exclusively is determined by the stage at detection and not by the mode of detection (screen-versus non-screen-detected), as long as the same stages are compared.…”

Self-Reported Opportunistic Screening Mammography in Austria – 2005 vs. 1995

“…Thus, considering the high prevalence of knowledge about opportunistic screening mammography -97% in our sample -our figures should be a good estimate of the opportunistic screening situation in Austria. Compared to Finland, the Netherlands, the United Kingdom, and Sweden -countries with an organized screening and participation rates of about 80% of the target population [13][14][15][16] -the usage of the opportunistic screening in Austria improved significantly within the past ten years and seems to be highly accepted and regularly claimed by women. The end point of screening has to be the reduction of breast cancer mortality, preceded by changes in the stage distribution and by a reduction of the absolute rate of advanced cancers [17].…”