Quality Determinants of Organized Breast Cancer Screening Programs

Methodology

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The Working Group on Quality Determinants of Organized Breast Cancer Screening Programs is composed of representatives from Canada with expertise in various areas of breast screening.

This is the second report published by this group. The inaugural report was released in 1997 and was a first step in many respects. The main initiative was to determine areas of quality for breast cancer screening programs by reviewing program standards in the National Health Service of the United Kingdom, and the United States guidelines for mammography. These areas were as follows: uptake, client satisfaction, high-quality screening, diagnosis, information systems, and the management of programs.

After consultation with the organized breast cancer screening programs in Canadian provinces, the final focus of the 1997 report included uptake (promotion and recruitment), client satisfaction (to minimize anxiety and maintain compliance), high-quality screening, and follow-up.

In this succeeding report, we have maintained and updated relevant information but have also rebuilt the way in which sections are presented. The report ends with diagnosis (not including treatment), and new sections have been added, including program evaluation, a proposed standardized pathological report (see Appendix), and the results of a survey on quality determinants in Canadian organized breast cancer screening programs. A pan-Canadian study on standardized interpretation of abnormalities and cancer detection ratios in organized breast screening programs is on course, following approval by the working group.

Thus, the layout of this report is as follows:

• Achieving quality through a client service approach;
• Recruitment and capacity;
• Retention;
• Quality of mammography;
• Reporting;
• Communicating results;
• Follow-up and diagnostic workup;
• Program evaluation;
• Special projects.

For each topic, questions were identified and a literature review was conducted. At least one working group member or consultant reviewed each piece of literature. Parallel to this, surveys of provincial breast cancer screening programs were conducted to document actual quality practices. Documentation of the practices of other national programs, in particular those from Australia and the United Kingdom, was also collected.

After review and discussion of the information collected, key recommendations for each topic were written during and between working group meetings. Consensus was used in developing the recommendations, and working group members accepted all statements unanimously.

All provincial program directors and the members of the National Committee of the Canadian Breast Cancer Screening Initiative reviewed the final report, which was approved at a National Committee meeting in November 2002.

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