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MaksimiljanKADIVEC Kristijana HERTL, Mateja KRAJC,
Katja JARM, Anže DROLC
IAEA, Vienna
MAY 2015
BREAST CANCER SCREENING
IN SLOVENIA
SLOVENIA
2.003.358 inhabitants
1.021.893 women, of them
262.400 aged 50 - 69
incidence: 2/1.000
1128 BC (2009)
434 died (2009)
Institute of Oncology
Ljubljana
Zaloška 2, 1000 Ljubljana
Slovenia
mkadivec@onko-i.si
Breast cancer is important problem of the public health
1128
434
Vir: SLORA
START
21. april 2008 (invitations in march – 3 week in advance)
GOAL:
LOWER THE MORTALITY RATE FOR
25 – 30 %
to discover cancers under 10 mm
European guidelines for
quality assurance in
breast cancer screening and diagnosis
(fourth edition)
Dr. Lawrence von Karsa (Lyon, France)
EBCN (European Breast Cancer Network) Coordination
Office
IARC (International Agency for Research on Cancer)
Dr. Margrit Reichel (Wiesbaden, Germany)
Leading radiologist for pilot screening breast cancer
program in Germany
Prof. Dr. Peter Dean (Turku, Finland) – Head of the breast
screening program in Finland
Prof. Dr. Peer Scane (Oslo, Norway) – Head of the
srceening reference center in Oslo
ORGANISATION of BREAST CANCER SCREENING
IN SLOVENIA - 2007
• age 50-69, invitation every 2 years
• centralisation of the screening
• only digital equipment
• appropriate education and training of
all personnel involved in the screening procedure
• double reading
(reader should read 5000 MM per year, lead radiologist 10000 MM per year,
first 3000 MM under control of lead radiologist)
ORGANISATION of BREAST CANCER SCREENING
IN SLOVENIA - 2007
• conferences: consensus, preop. , postop.
• daily, weekly quality control of mammography machines
• no clinical examination
• setting of an adequate information system
• analysing performance indikator
Σ = 64.683
16.056
I.
II.
III.
Target population (50-69): 262.400
Average cumulative incidence rate
1998–2002
4,68-5,37
5,38-6,06
6,06-6,74
6,75-7,42
7,43-8,11
5.954
162 000
100 000
ADVANTAGES
• Professionalism of the staff: kindness, discretion
and mainly humanity
• accuracy
• friendly environment
• good marked way to the screening place
• speed of the report, assessment, operation
• addditional education of staff
• quality of the equipment
EDUCATION
BREAST CANCER SCREENING IN SLOVENIA
RADIOLOGISTS
Course for Lead radiologist and Readers 2 days
Course for US + biopsy (only Lead radiologist) 2 days
Lead radiologist - practice (reference center) 1 month
Readers – practice (reference center) 1 week
RADIOGRAPHERS
Positioning course 2 days
Practice (reference center) 14 days
ALL (radiologist, radiographer, surgeon, patologist, administrator, nurse)
MDC – Multidisciplinary Course (2 days)
Refreshment course every 2 years for radiographers and radiologists
WE ADD for all: 2 days course of communication skills !!!
MEDICAL PHYSIST
• on line every day
• mammograph every 6 months
• controle of the diagnostic monitors (5MP)
PGMI
•P (Perfect)
•G (Good)
•M (Moderately good)
•I (Inadequate)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1 3 5 7 9 11 13 15 17 19 21 23
DORA radiographers
statistics sept 2013 – march 2014
I
M
P+G
Dora Information System
• Process based
• Task lists for all profiles:
radiologist, surgeons, pathologist,
administration
• Clinical data is stored
in openEHR archetypes and
templates
• Seamless integration with RIS
• Ware house
EHR Platform is used in Moscow City's EHR project.
electronic file of the women
Modules
• Central registry
• Call center
• Mammographies
• Double blind screening
• Consensus
• Assessment
• Integration module
• eCRP
Radiologist result form
invitations
map
Mobile unit
TIMETABLE
M T T T M M W T W W T F F F
Double reading
CONSENSUS
Invitation for assessment - 4,5%
ASSESSMENT
Discussion with patients
10%
1,8% needle biopsy
M T T
PRE AND POSTOPERATIVE
CONFERENCE
10 - 15 days
consensus conference
pre and post operative conference
SCREENING
TEAM
EPIDEMIOLOGIST
PATHOLOGIST
SURGEON
IT
RADIOLOGIST
RADIOGRAPHER
SEKRETARY BREAST NURSE
PHISIST
Performance indicator
Programme DORA EU acceptable EU desirable
value level level
Proportion of women invited that attend for
screening 72.1% > 70% > 75%
Coverage of eligible women 31.8% / /
Proportion of women recalled for further
assessment
Initial screening
examinations 4.5% < 7% < 5%
Subsequent screening
examinations 2.3% < 5% < 3%
Breast cancer detection rate per 1000
screened
Initial screening
examinations 7.6/1000 7.5/1000 > 7.5/1000
Subsequent screening
examinations 4.1/1000 3.7/1000 > 3.7/1000
Performance indicators in Slovenian breast cancer screening programme
Dora, 21.4.2008 – 31.12.2012.
Proportion of screen - detected cancers
that are stage II+
Initial screening
examinations 35.5% -- < 30%
Subsequent screening
examinations 24.4% 25% < 25%
Proportion of invasive screen - detected
cancers that are <= 10 mm in size
Initial screening
examinations 33.7% / >= 25%
Subsequent screening
examinations 26.5% >= 25% >= 30%
Interval cancer rate as a proportion of the
underlying, expected, breast cancer
incidence rate in the absence of screening
Within the first year (0-
11 months) 20% 30% < 30%
Within the second year
(12-23 months) 48% 50% < 50%
Time (in working days) between result of
screening mammography and offered
assessment 3.6 working days 5 wd 3 wd
Updated on 17.3.2014
Performance indicators in Slovenian breast cancer screening programme Dora,
21.4.2008 – 31.12.2012.
Programme DORA EU acceptable EU desirable
THANK YOU
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