Diapositiva 1 - Osservatorio Nazionale Screening

Finalborgo, 19-20 maggio 2016
Workshop GISMa - ONS
Lo screening mammografico in
Europa
Antonio Ponti e Mariano Tomatis
CPO-Piemonte
Implementation of EB cancer screening programmes,
with an organised, population based approach with
QA at all appropriate levels
(Raccomandazione del Consiglio Europeo del 2003)
The European Screening Implementation report
(previsto dalla raccomandazione del Consiglio Europeo del 2003)
First report
2008
The European Screening Implementation report
Definitions needed:
Programme y/n
Organised y/n
Pop based y/n
If yes, roll out complete …
The European Screening Implementation report
Results:
22 / 28 Population based
11 / 22 Roll out complete
Poster at the ICSN Meeting, 2015
0%
25%
50%
75%
100%
Proportion of women with complete information in 39 countries/regions *
Italy: 80%
* Areas providing data for 50-69 years
0%
25%
50%
75%
100%
Invitation coverage in 46 countries/regions *
Italy: 70,6%
* Areas providing data for 50-69 years
0%
25%
50%
75%
100%
Examination coverage in 46 countries/regions *
Italy: 39,1%
* Areas providing data for 50-69 years
0
25
50
75
100
Participation rate in 30 countries/regions *
Italy: 55,4%
* Areas providing data for 50-69 years. Initial and subsequent invitations.
0
5
10
15
20
25
30
PPV (%) of a positive screening test in 24 countries/regions *
Italy: 7,6% (FA 5.8%; DR 4.3 per 1000)
* Areas providing data for 50-69 years. Initial and subsequent tests.
A precursor: the EUNICE project
and monitoring system
EUNICE BREAST SCREENING MONITORING
Insert login & password
and click on “Login”
Selection of the area
In order to see the total results
of examined areas, select
“Summary of all areas”
and click on “View”
Selection of the period
Select the period to be analized.
In order to analize all available
periods select “All”.
Click on “View”.
Analysis of data from all areas
Indicators have a green background: they can
be clicked in order to get the stratified results
Analysis of data from all areas
In the list you can find areas, numerators &
denominators of the indicator and its results.
Selection of the area to be analized
In order to see the data of a single
area, select it and click on “View”.
Analysis of selected areas
22 forms are available, and they can be accessed
through the combo box at the bottom or
browsable with the two icons (Previous/Next).
Section
title
Green
background
clickable
indicators
Analysis of selected areas
In the “Outcome of surgical referral” form
you’ll find a link to a more detailed report on data
(click on “detailed report” to open it)
Analysis of selected areas
One data collection, many points of view
C
International
You
International mean
In attesa dei dati del secondo Screening Report …
…Qualche altro risultato da Eunice
Pilot study: respondent European Countries (n=18)
EUNICE Breast cancer screening monitoring
Reported screening tests 50-69
Area
Belgium Flanders
Czech Republic
Denmark Copenhagen
Estonia (50-59)
Finland
Germany
Hungary (50-65)
Italy
Luxembourg
Netherlands
Norway
Poland
Portugal centre
Period
Initial
2005
47104
2005-2006 256425
2005
3681
2005-2006
20555
2005
0
2001-2004
0
2005-2006
0
2005
170427
2004-2005
5094
2005
62025
2005-2006
76058
2007
403596
2005
13841
Portugal north
Republic of Ireland (East) (50-64)
Spain Galicia (50-66)
Spain Navarra
Spain Pais Vasco (50-64)
Spain Valencia
Sweden Sodermanland
Sweden Stockholm
Sweden Vastmanland
Switzerland Fribourg
UK England
All Areas
2005
2005
2005-2006
2005-2006
2005
2005-2006
2005
2005
2005
2005
2005-2006
EUNICE Breast cancer screening monitoring
12299
18744
28774
734
0
15826
0
8102
0
5790
531870
1680945
Subsequent Unknown Total
87252
0
134356
234900
0
491325
13216
0
16897
0
17112
37667
211183
0
211183
0
80388
80388
347601
0
347601
576207
22177
768811
22923
0
28017
668238
0
730263
283184
11536
370778
531820
0
935416
44606
0
58447
12709
41098
142902
54139
0
304442
0
63870
0
0
2582335
6222625
0
0
0
0
74636
0
12192
0
12138
1096
285832
517107
25008
59842
171676
54873
74636
320268
12192
71972
12138
6886
3400037
8420677
Breast cancer screening programmes features:
Country, area
Belgium Flanders
Czech Republic
Denmark Copenhagen
Estonia
Finland
Germany
Hungary
Italy
Luxembourg
Netherlands
Norway
Mammography views at
screening
2
2
2 at first screening;
1 at subsequent screening
2
2
2
2 at first screening;
1 at subsequent screening
2
2 at first screening;
1 at subsequent screening
2
DIAGNOSTIC PROCESS
Any additional test
no (except US in
case of breast
implants)
Double reading
Further
assessment on
recall
yes
yes
occasionally after SC only
no
no
no
occasionally after SC and after FA
no
no
no
no
physical examination
(100%)
yes
yes
yes
yes
yes
yes
yes
yes
no
occasionally after FA only
yes
yes
occasionally after SC and after FA
no
no
yes
yes
yes
yes
occasionally after SC and after FA
occasionally after SC only
no
no
yes
yes
yes
yes
Intermediate mammograms
occasionally after FA only
Poland
Portugal centre
Portugal north
2
2
2
no
no
no
no
yes
yes
yes
yes
yes
occasionally after SC and after FA
occasionally after FA only
occasionally after FA only
Republic of Ireland (East)
2
no
yes
yes
occasionally after FA only
Spain Galicia
2
no
yes
occasionally after SC and after FA
Spain Navarra
2
no
no
yes
yes (in 98% of
cases)
2
2 at first screening;
1 at subsequent screening*
2 at first screening;
1 at subsequent screening
2 at first screening;
1 at subsequent screening
2 at first screening;
1 at subsequent screening
2 at first screening;
1 at subsequent screening
2
no
no
yes
occasionally after SC and after FA
no
yes
yes
occasionally after SC and after FA
no
no
no
yes
yes
no
yes
yes
yes
yes
yes
yes
Spain Pais Vasco
Spain Valencia
Sweden Sodermanland
Sweden Stockholm
Sweden Vastmanland
no
EUNICE
UK England Breast cancer screening monitoring
no
Switzerland Fribourg
occasionally after SC and after FA
occasionally after FA only
occasionally after FA only
en
U
K
So E
de ng
l
D
en S rm and
a
m pa n
ar in lan
k
Co Na d
p e var
S w N nh r a
Sw ed eth age
ed en er l n
en S t an
W ock ds
as h
tm olm
an
Sp
la
nd
ai
n
R
ep
P
ub P ais Ital
lic or t Va y
o f u g sc
o
Ire al
n
Po lan ort
rt d ( h
u
E
Sp gal as
ai ce t)
n
Va ntre
Sp le
ai n c
n
G ia
al
C
ze N icia
ch or
Re way
pu
H blic
un
g
G ar
er y
m
a
Es ny
to
ni
Sw
a
itz Lu Pol
x
a
er
e
la m nd
b
n
B
el d F ou
r
gi
um rib g
ou
Fl
an rg
de
rs
Sw
ed
5.000
0
ECCG-ECN-EUROCOURSE
Warsaw, Poland, 20-22 May 2010
North
East
South
Count
23
Mean
8,706
Median
7,318
781
861
1.557
2.688
4.107
20.000
5.024
25.000
5.155
5.657
6.180
6.603
7.216
7.318
7.495
8.031
8.470
8.718
9.809
12.729
13.705
16.897
18.522
21.222
21.494
Average number of tests per unit
centralization of screening
15.000
10.000
West
DR (invasive) rate (Overall 4.94 per 1000, 1.6-9.2)
Subsequent test
10
9
7,45
8
7
5,61
6
5
4
4,24
3,10
3
2
1
0
50-54
55-59
EUNICE Breast cancer screening monitoring
60-64
65-69
Benign surgical biopsies rate (Overall 0.76 per 1000, 0.3-1.4)
Subsequent test
10
9
8
7
6
5
4
3
2
1
0,86
0,67
0,68
0,71
50-54
55-59
60-64
65-69
0
EUNICE Breast cancer screening monitoring
Subsequent screening tests
EUNICE Breast cancer screening monitoring
Conclusioni
Il monitoraggio Europe-wide di indicatori di processo
dello screening per mezzo di una raccolta dati
standardizzata è fattibile e la qualità dei dati è
ragionevolmente buona.
Con organizzazione e risorse adeguate questa attività
potrebbe diventare stabile e assumere un ruolo di
sostegno e di salvaguardia della qualità dello
screening in Europa attraverso un utilizzo distribuito e
l’emissione di report periodici.
EUNICE Breast cancer screening monitoring