A decentralized breast cancer screening program in the French department of Bas-Rhin

Since 1989, in the french department of Bas-Rhin, a breast cancer screening program in going on and its results are presented here. This program, conc erning women of 50 to 65 years-old, is decentralized, based on private or p ublic radiologists and the motivation of women because there is no invitati on. The interval between screening test is 2 years. After 8 years, the resu lts are rather satisfactory: participation rate of the initial cohort is 77 % in December 31th 1997, participation at incident screenings is above than 85%, early indicators (recall rate, detection rate, PPV of screening, PPV of biopsy) are improving with time to attain numbers like international stu dies. The ADEMAS program shows that a decentralized screening program, base d on existing medical structures is possible in France. Anyway, it must be organized, evaluated at any time, with a quality assurance system to guaran tee the women the best taking charge.