APH 2000, 58, 131-144:

Evaluation of a pilot quality assurance programme for breast cancer screening in the Brussels area.

F. Renard, C.D. Bourdon, M. Andry, V. Mendez, A-R. Grivegnée, A. Vandenbroucke

Keywords: quality assurance, mammography screening, double reading, early indicators, evaluation

Background: a pilot quality assurance project for breast cancer screening was set up in the Brussels area in 1994.  This paper aims to assess the performance of this programme after 4 years of activity, and the specific impact of consensual double reading of mammograms.

Methods: each screening mammogram of women aged 50-69 year was submitted to a consensual double reading.  Results of readings were registered with standardised forms.  Follow-up data were traced for every positive mammogram.

Results: 15.624 mammograms were performed in 12.239 women; recall rate at first round was 7,8%, open biopsy rate was 1% cancer detection rate was 5,8%, positive predictive value of biopsy recommendation was 53,4%, benign to malignant biopsy ratio was 0,87:1, small size (less or equal to 10 mm) cancer proportion was 40%, proportion of cancers free of nodal involvement was 65%.  Double reading yielded a 6% gain in sensitivity, while recall dropped from 8,1% to 7,8%.

Conclusion: apart from a too high recall rate, screening performance was comparable with other published results in the same context; performance indicators ranged within norms recommended by "Europe against cancer".  However, impact of double reading was weak and should be re-evaluated in the future perspective of a larger scale organised programme.