Consequences of a national mammography screening program on diagnostic procedures and tumor sizes in breast cancer - A retrospective study of 1540 cases diagnosed and histologically confirmed between 1995 and 1997

In 1992, a national. screening mammography program, including female patien ts between 50 and 64 years of age, was launched in Luxembourg. The effects of this campaign on the different diagnostic procedures, especially fine ne edle aspirations (FNA), large core needle biopsies (LCNB), and surgical spe cimens, were analyzed. From 1983 to 1997, the National Cancer Registry recorded 3167 new cases of invasive female breast cancer, all histologically diagnosed in one central pathology department. In 1996, the population consisted of 418,300 inhabita nts (212,900 females). The number of breast cancer, tumor size, the nature of the diagnostic procedures, their diagnostic value as well as the number of physicians, "aspirators", and "biopsists" were evaluated. Between 1992 and 1994, the incidence of invasive breast cancers increased, concomitant with the launching of a National Screening Mammography Program. The diagnosis of in situ cancers tripled, and the mean size of invasive br east cancer decreased from 2.1-2.4 cm to 1.1-1.4 cm. Since 1994, the number of FNA had remained stable, LCNB had increased by 417.5%, and surgical bio psies had decreased by 18.95%. Between 1995 and 1997, 28.37% of 1075 FNA, a nd only 9.6% of 465 LCNB yielded inadequate samples. FNA were done by 77 di fferent doctors (53.25% being gynecologists) and LCNB by 34 (52.94% being r adiologists). The first diagnoses of all invasive cancers (n = 790) were ma de by using frozen sections from surgical specimens in 58.35% (n = 461), LC NB in 18.23% (n = 144), mastectomy in 10.13% (n = 80), formalin-fixed biops ies in 9.49% (n = 75), and FNA in 3.17% (n = 25). There are beneficial effects (increase in the number of diagnoses of in sit u cancer; decrease in tumor sizes) not only for the "target" age group (50- 64 years), but also for all female age groups (> 15 years). For quality ass urance purposes, it is absolutely recommended to carry out pathological, ra diological, and diagnostic work in specialized centers.