European Commission - Public Health: healthindicators.org

Breast cancer screening

Definition of indicator

Indicator is defined as the percentage of women (aged 50-69) that have undergone a breast cancer screening test, measured as the coverage rate of mammography testing. Individuals are asked during a population survey if they had a breast cancer screening. These actions rather refer to the concept of preventive medicine: activities and interventions that focus on prevention and control of risk factors, prevention and early detection of disease. The use of preventive health care has been defined as that provided by professionals, as well as the use of specific devices and measures used or taken by individuals. The respondent is not required to produce any kind of proof that the screening was effectively performed. The statement of the respondent is thus used with all the subjectivity that may go with.

Calculation (numerator, denominator)

Derived from EHIS questions PA.10 and PA.11: Percentage of women aged 50-69 reporting to have had a breast examination by X-ray (ie. mammography) within past 2 years.

PA.10: Have you ever had a mammography, which is an X-ray of one or both of your breasts?

Yes / No / Don’t know / Refusal; and

PA11. When was the last time you had a mammography (breast X-ray)? Within the past 12 months / More than 1 year, but not more than 2 years / More than 21 year, but not more than 3 years / Not within the past 3 years / Don’t know / Refusal

Additional underlying concepts

Breast cancer screening should be performed according to defined quality criteria (e.g. certified screening centers), which is not specified in EHIS questions. While the target group for breast cancer screening is limited to women 50-69 years, it may be interesting to measure the screening coverage also in other groups such as women 40-49 years.

Relevant dimensions (subgroups)

Country (also region), calendar year

Preferred data sources

(1) currently: national HIS

(2) in the future: EHIS (Questions PA10, PA11 and PA12)

Rationale

Breast cancer is the most frequent cancer among women; it represents 15 to 35% of all cancers diagnosed in Europe. Breast cancer screening programmes based on mammography and organised at the population level allow effectively to decrease the breast cancer mortality by 30% among women aged 50 to 69 years. One of the requisites however is that at least 70% of the women take effectively part to the screening programme. The publication of European guidelines indicates that this domain of cancer screening is a priority in the public health. Information collected in population surveys can be directly used by the public health decision makers in order to possibly adapt the organisation of the prevention/screening programmes.

Data availability, quality and periodicity

- WHO-HFA and OECD database: no data available on breast cancer screening.

- Eurostat: The Eurobarometer surveys carried out in 1996 and 2002 included a question on cancer tests: (EB 186 Wave 59.0. Q.27: Over the last twelve months, which, if any, of the following tests have you had? Breast examination by X-ray, that is mammography; Breast examination by hand.) Eurobarometers are not the optimal source of information, because due to their small sample size, it is not possible to present reliable figures by gender and age.

- National HIS: Only a few countries have included questions on breast cancer screening in their national health surveys, with some problems of comparability between countries.

- It is likely that there is a bias between the declaration of the respondent and the effective screening. One can expect however that such a bias will not vary much from one survey to the other and that it will thus be interesting to follow up trends of the coverage over time.

- EHIS implemented 2007-2009. Data will thus be available in the coming years (and will be pooled by Eurostat).

References

- EHIS standard questionnaire (version of 11/2006)

- European guidelines for breast cancer screening

- Cancer Screening in the European Union - Report on the implementation of the Council Recommendation on cancer screening

- Health Care Quality Indicators, OECD Working Paper, Health Care Quality Indicators Project, Inital Indicators report, Part III - Indicators Specifications and Data Results, DELSA/HEA/HCQ(2005)2/ANN, 2006

- European Cancer Health Indicator Project, EUROCHIP

- European Union Health Surveys Information Database

Work to do

• Age group has to be defined, e.g. 35+, 40+, 45+ , 50-69? Suggestion: 50-69. YES

• Ask Eurostat to provide the exact mode of calculation for the indicator (for a reference of 2 years)

• Check: Breast Cancer Screening coverage has been investigated in the HCQI Project.

• Check: Results from some countries are available in the HCQI-Report

• Check: OECD Health Care Quality Indicators Project -> % women 52-69 receiving bilateral mammography within past year. Yes.

• Is there any register/admistrative based data? Yes, at least in Finland, any other countries?