Breast cancer screening in 21 countries: delivery of services, notification of results and outcomes ascertainment

Following clinical trial evidence of mammography screening's efficacy and e ffectiveness, data are needed from organized population-based programmes to determine whether screening in these programmes results in breast cancer m ortality reductions comparable to those demonstrated in controlled settings . The International Breast Cancer Screening Network (IBSN) conducted two in ternational programme assessments: in 1990 among nine countries and in 1995 among 22 countries, obtaining information on the organization and process for screening within breast cancer screening programmes, This manuscript de scribes procedures for recruitment, service delivery, interpretation and co mmunication of results, case ascertainment, and quality assurance. Practice s in more established programmes are compared with pilot programmes, Each I BSN country defined a unique programme of population-based breast cancer sc reening. Some programmes were sub-national rather than national in scope, w hile others were in pilot stages of development, Screening took place in de dicated centres in established programmes and in both dedicated and general radiology centres in pilot programmes. Although most countries used person al invitation systems to recruit women to screening, other recruitment mech anisms were used. Most countries used two-view mammography in their screeni ng programmes. About half had implemented independent double reading of mam mograms, considering it a key component of high-quality mammography screeni ng. In conclusion, diversity exists in the organization and delivery of scr eening mammography internationally. Quality assurance activities are a prio rity and are being evaluated in the IBSN, (C) 1999 Lippincott Williams & Wi lkins.