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Australia, Austria, Belgium, Canada, Czech Republic, Denmark, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Japan, Korea, Luxembourg, Mexico, Netherlands, New Zealand, Norway, Poland, Portugal, Slovak Republic, Spain, Sweden, Switzerland, Turkey, United Kingdom, United States,

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Mammography screening - Breast cancer screening, survey data and programme data

Mammography rates.

Numerator: Number of women age 50-69 reporting having received a bilateral mammography according to the specific screening frequency recommended in each country.

Denominator: Number of women age 50-69 answering survey questions on mammography or eligible for organised screening programme.

Note: in most countries, the recommended screening frequency will be every year or every two years.

Sources and Methods

Summary table

Programme data		Survey data
Australia	Luxembourg	Austria	Korea
Belgium	Netherlands	France	Mexico
Canada	New Zealand	Greece	Poland
Czech Republic	Norway	Italy	Turkey
Finland	Portugal	Japan	United States
Germany	Slovak Republic
Hungary	Sweden
Iceland	United Kingdom
Ireland

Australia

Australian Institute of Health and Welfare 2008. BreastScreen Australia monitoring report 2004-2005. AIHW Cat. No. CAN37. Canberra: AIHW (and previous issues). Also at www.aihw.gov.au.
* Population: National, representative sample.
* Age variation: 50-69 years old.
* Programme or survey: programme.
* Recall period/periodicity: 2 years.
* The data is crude rates, and represents the proportion of women in the target population participating in the national screening programme over a 24-month period, hence the 2005 rate refers to both 2004 and 2005.

Austria

* 2006/2007: Austrian Health Interview Survey.
The survey will be repeated every 5 years.
* Recall period: past 12 months.
* Recommended periodicity: every two years for women aged 40 years and over.
* Denominator: number of women aged 50 to 69 years answering the Austrian Health Interview Survey.

Belgium

Programme de Dépistage du Cancer du Sein. Periods 2001-2002, 2003-2004 and 2005-2006. Report number 6 from the Agence Intermutualiste. January 2009 (http://www.nic-ima.be/).
* Population: National.
* Age variation: 50-69 years old.
* Programme or survey: programme.

Canada

Survey Data
Statistics Canada, National Population Health Survey, 1996/97 and 1998-99 and Canadian Community Health Survey, 2000/01, 2003 and 2005.
* Population: National, representative sample.
* Age variation: 50-69 years old.
* Recall period/periodicity: 2 years.
* The percentage of females aged 50 to 69 who received routine screening mammogram or who received mammogram within the last two years for other reasons. The breakdown is as follows:
         

Year	Received routine screening Mammogram	Received mammogram for other reasons	Total
1996/97	49.4%	12.1%	61.5%
1998/99			66.3%
2000/01	54.8%	17.7%	69.5%
2003/04	49.1%	21.6%	70.6%
2005/06	50.8%	19.6%	70.4%

Programme Data: Health Canada, Organized Breast Cancer Screening Programs in Canada, 1999 and 2000 Report (2003).
Public Health Agency of Canada, Organized Breast Cancer Screening Programs in Canada, Report on Program Performance in 2001 and 2002 (2005).
* For the purposes of the Canadian Breast Cancer Screening Database (CBCSD), the target population is defined as asymptomatic women between the ages of 50 and 69 years with no prior diagnosis of breast cancer. All provincial /territorial programmes screen some women outside the target age group, although they are not actively recruited. In 1999 and 2000, the percentage of total screens that were delivered to women aged 50 to 69 ranged by province from 50.3% to 100%. In 2001 and 2002, it ranged from 51.1% to 100.0%.
* While some provinces are delivering the vast majority of their breast screening services through organized programs, Canada-wide data indicates that a considerable proportion of screening is delivered through the fee-for-service sector.

Czech Republic

National Breast Cancer Screening Database
* Processor: Institute of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science of the Masaryk University, see http://www.iba.muni.cz.
* Population: The database comprises all examinations performed in accredited screening centres participating in the National breast cancer screening programme in the Czech Republic. For the first quarter of 2004, only estimation from aggregated data for one centre.
* Age variation: percentage of women at age 50-69 years screened in the given two year period, which is the recommended time period in the Czech Republic.
* Programme or survey: programme.

Denmark

* Data not available.

Finland

National screening programme.
* Population: national, representative sample
* Age variation: 50-59 years old up to 2006; 50-69 years old since 2007.
* Programme or survey: programme.
* Recall period/periodicity: 2 years.
* Comments: Finnish public health statutes: the screening interval is two years, and it covers the population between 50 and 69 years, since 2007and 50-59 years until end of 2006. The Finnish health information system collects information on cancer screening from individuals, based on issued personal invitations to undergo screening. With the help of personal identification numbers, it is possible to follow up all invited women to know how many participated in the cancer screening.
* In year 2005, 99% of women aged 50-59 (target age) were invited for organised cervical cancer screening and 87% participated (71% of those invited). In addition, some municipalities also invited women aged 60-64 or 65-69 years (34% and 18% respectively) and 88% and 86% of those invited participated, respectively.
* In year 2006, 100% of women aged 50-59 (target age) were invited for organised breast cancer screening and 86.5% participated. In addition, some municipalities also invited women aged 60-64 or 65-69 years (36.3% and 20.0% respectively) and 86.8% and 85.8% of those invited participated, respectively.

France

Survey data: Survey on health and social protection, IRDES (http://www.irdes.fr).
* Age variation: 50-74 years old.
* Recall period/periodicity: 2 years.
* The Institut de Recherche et Documentation en Economie de la Santé (IRDES) carries out every couple of years a survey on health and social protection ("Enquête sur la santé et la protection sociale (ESPS)") which includes data on mammography rates. But the numerator and denominator are different than those requested by the OECD:
- Numerator: Number of women aged 50-74 reporting having received a bilateral mammography within the two last years.
- Denominator: Number of women aged 50-74 answering survey questions on mammography or eligible for organised screening programme.
Programme data: Breast cancer screening is recommended every two years to women aged 50 to 74 years old. A national programme extended to the entire territory has been in place since 2004. Data provided correspond to participation to screenings organised over the course of two years since 2004 (i.e. 2004-2005, etc). Note that participation to screening differs from screening coverage over two years, as organised screening co-exist with individual screening. Hence data from the national programme are often under-estimated compared to survey data, for which there exists a bias linked to the fact people tend to report the date of the latest screening as more recent than it actually was.
* Data reported in 2005, 2006 and 2007 refer to 2004-2005, 2005-2006 and 2006-2007 respectively.

Germany

Kooperationsgemeinschaft Mammographie, Mammographie-Screening-Programm.
http://www.kooperationsgemeinschaft-mammographie.de
* Age variation: 50-69 years old.
* Programme or survey: programme.
* Women are invited to screening based on the inhabitants’ registries. Each woman should be invited every two years. The examination and assessment is free for the women.
* In the years 2005 to 2007 2.68 million women aged between 50 and 69 years were asked to undergo a mammogram examination. All in all 10.4 million women were entitled to (79 of 94 reference regions). This corresponds to an attendance rate of about 54%.
* Comments: 2002 the German parliament had decided to introduce service screening in Germany for women aged 50–69. The programme strictly follows the ‘European Guidelines for Quality Assurance in Mammography Screening and Diagnosis’. The program is put into reality by an institution called ‘Kooperationsgemeinschaft Mammographie’. The ‘Kooperationsgemeinschaft Mammographie’ is responsible for additional regulations, for interpretation of the regulations, for all certifications and recertifications. It is supported by 6 Reference Centers, which are responsible to offer training courses and offer possibilities for secondment to technologists and doctors involved in the program. Germany is split up into 94 reference regions, and it has been decided that one or two doctors have to be responsible for the program in each of the regions. The responsibilities include medical and organizational issues for the whole program in that area.

Greece

For 2006 data:. “Hellas Health I” survey, Center for Health Services Research, Medical School, University of Athens
* Population: National, representative sample.
* Age variation: 50-69 years old.
* Programme or survey: survey.
* Recall period/periodicity: mammography within past 2 years.
For 2008 data:. “Hellas Health II” survey, Center for Health Services Research, Medical School, University of Athens
* Population: National, representative sample.
* Age variation: 50-69 years old.
* Programme or survey: survey.
* Recall period/periodicity: mammography within past 2 years.

Hungary

Hungarian National Health Insurance Fund (OEP). www.oep.hu.
* Population: National.
* Age variation: 45-65 years old.
* Programme or survey: programme.
* Recall period/periodicity: 2 years.
* Comments: organised screenings for breast cancer started in January 2002 in Hungary.

Iceland

Cancer Detection Centre of the Icelandic Cancer Society, Ministry of Health.
* Population: National, full population.
* Age variation: 40-69 years old.
* Programme or survey: programme.
* Recall period/periodicity: 2 years.

Ireland

Breastcheck.
* Population: Regional. Half of national female population aged 50 to 64 currently covered by programme since 2000.
* Age variation: 50-64 years old.
* Programme or survey: programme.
* Recall period/periodicity: 2 years.

Italy

* Source:
- Since 2004: Ministry of Health.
- Data referred to 2004-2007: Ministry of Health - National Centre for Screening Monitoring.
http://www.osservatorionazionalescreening.it/eng/about_us.htm.
Coverage:
- In 2004, target population corresponds to 52,0% of resident women aged 50-69 years old.
- In 2005, target population corresponds to 50,3% of resident women aged 50-69 years old.
- In 2006, target population corresponds to 57,6% of resident women aged 50-69 years old.
- In 2007, target population corresponds to 62,3% of resident women aged 50-69 years old.
* Periodicity: yearly.
* Calculation method:
Numerator: Number of women aged 50-69 that have received a bilateral mammography through an annual organised programme within the past year.
Denominator: Number of women aged 50-69 involved in organised screening programme.
* Data referred to 2000: ISTAT. Indagine Multiscopo Sulle Famiglie. Condizioni di salute e ricorso ai servizi sanitari. Roma 2002.
* The data referred to 2000 comes from population-based surveys.
* Population: National, representative sample. Age variation: 55-69.
* Programme or survey: survey.
* Recall period/periodicity: 2 years.
* Comments: Numerator is an estimation of the number of Italian women who have undergone a preventive mammography over the past two years. Refers to all mammographies performed either within or outside of organised programmes. Denominator is a proxy of Italian women in the same age range (55-69). Data collected as a result of a Multipurpose National Survey on Health Condition interviewing a representative sample of Italian women about preventive practices. Women aged 50-69 are invited to a screening mammography every two years. Coverage from screening programmes was estimated to be near 47% in 2001 and the mean value of participation in Italian Breast Screening Programs is 53.6%. Mammographies executed inside screening programmes in 2001 were 567,224 (Source: Osservatorio Nazionale per la Prevenzione dei Tumori Femminili. Secondo Rapporto, Lega Italiana per la Lotta contro i Tumori, 2003).

Japan

Ministry of Health, Labour and Welfare, Comprehensive Survey of Living Conditions.
* Population: National, full population.
* Age variation:
- Numerator: Number of women aged 50-69 in a household reporting having received a breast cancer screening over the past one year of the survey. It includes other kinds of screening than mammography. The breast cancer screening frequency recommended in Japan is every 2 years. - Denominator: Number of women aged 50-69 in a household answering survey question on breast cancer screening.
* Programme or survey: survey.
* Recall period/periodicity: Every 3 years from 2001.

Korea

Institute for Health and Social Affairs, Report on the National Health and Nutrition Survey in 2005 and 2006.
* Population : National, representative sample.
* Age variation: 50-69 years old.
* Programme or survey: survey.

Luxembourg

* Since 1992, a national screening programme for breast cancer has been in place, under the common responsibility of the  Ministère de la Santé and the National Health Insurance (CNS).
* Note that on January 1st, 2009 the Union of Sickness Funds changed its denomination to « National Health Insurance ».
* Population: national, female population residing in Luxembourg and covered by sickness insurance.
* Age variation: 50-64 years old (for 2000 data), 50-69 years old (since 2001).
* Programme or survey: programme.
* Recall period/periodicity: 2 years.
* Comments: every two years, women are invited to undergo two mammographies for each breast in one of Luxembourg's clinics.

Mexico

National Survey on Health and Nutrition 2006. Ministry of Health. National Institute of Public Health. Final results:
* Age variation: 50-69 years old.
* Programme or survey: survey.
* Results are from 48,000 households. Data included 32 states. The survey is representative at national and state level.
* Comments: Data corresponds to the percentage of women aged 50 to 69 years old, who attended the preventive medicine module for detection of breast cancer (mammography) during the last 12 months.

Netherlands

Survey data from 2001 onwards: Statistics Netherlands, Health Interview Survey.
* Women who had a mammography at least once during the last two years.
Programme data: LETB, Landelijk Evaluatie Team voor bevolkingsonderzoek naar Borstkanker (National Evaluation Team for Breast Cancer Screening NETB), Landelijke evaluatie van bevolingsonderzoek naar bortskanker in Nederland. 2002 (X)Het tiende evaluatierapport en 2004 Tussenrapportage. (National evaluation of breast cancer screening in the Netherlands. 2002 (X) Tenth evaluation report and 2004 Interim report). Rotterdam: LETB, Erasmus MC, 2002, 2004.    
* Population: National, full population.
* Age variation: 50-75 years old.
* Programme or survey: programme.
* Recall period/periodicity: 2 years.
* Comments: Netherlands Bevolkingsonderzoek naar Borstkanker (Breast Cancer screening programme in the Netherlands.) Every two years women aged 50-75 are invited for screening. In 2002 the target population was 1 090 000. Actual invited population was 1 059 000. Women who do not respond, receive a reminder invitation after 2-3 months. Women who declared they did not want an invitation anymore (definite refusers) and women with an interval or screening carcinoma do not receive an invitation for subsequent screens. The screening is organised and carried out by nine regional screening organisations. All invitations, screen examinations and screen results are recorded at the individual level in the regional information systems. The screening organisations are connected to the computerised municipal population registry that provide address details of the eligible women and information on whether these women have died or moved out of the region.

New Zealand

BreastScreen Aotearoa (BSA) a screening programme of the National Screening Unit, a separate unit of the Ministry of Health.
* Population: National, general sample.
* Age variation: 50-64 years old. Changed to 45-69 years old as of July 2004.
* Programme or survey: programme.
* Recall period/periodicity: 2 years.
* BreastScreen Aotearora (BSA) has offered government funded biennial mammography screening for all New Zealand women aged 50-64 years , since 1999. In July 2004, the target group was extended to include women aged 45-49 years and 65-69 years.
* 2003-2007 figures: Coverage is a population-based measure of the percentage of women in the target age-range (50-69 years) who had a screening mammogram in the programme, during the 2 year period to the end December of each year. Both first screening events (women newly enrolled in the programme) and subsequent screening events (women already enrolled) are included in the coverage figures.
* Coverage figures do not include women screened privately or high-risk women screened annually outside of BSA (in diagnostic services)
* 2003-2005 coverage figures are for women aged 50-64, from 2006 figures are for women aged 50-69 years.
* The programme figures include only those women screened within the public health system and do not include those screened privately
* All figures are annual for the year ending December,
* The 2006/2007 New Zealand Health Survey includes a question on mammography screening. However, BSA’s data sources are considered a more accurate record of screening events than the national survey for calculating total population coverage.
* Usually National Health Survey shows a greater screening coverage than the BSA programme figures, because the survey includes women who have screening mammography outside of the national screening programme.
* The survey figures include all women who have had a mammogram within the previous 2 years.
Sources: Independent Monitoring Reports, National Screening Unit, Ministry of Health, New Zealand.
2007 New Zealand Health Survey, Ministry of Health, New Zealand

Norway

Norwegian Breast Cancer Screening Programme.
* Population: National, full population.
* Age variation: 50-69 years old.
* Programme or survey: programme.
* Recall period/periodicity: 2 years.
* Comments: Nationwide since February 2004, 2 views, 2-year screening interval. Quality assurance manual based on EU guidelines.

Poland

2004 data: Central Statistical Office. Health Interview Survey conducted by CSO.
* Programme or survey: survey.
* Instrument comprises of following questions:
1. Have you ever had a mammography? Yes; No.
2. When was the last time you had a mammography? Give the number of years (if during the last year – write 0).

Portugal

Programa de rastreio cancro da mama da regiao centro (Liga portuguesa contra o cancro).
* Population: Regional, generalisable.
* Age variation: 50-69 years old.
* Programme or survey: programme.
* Recall period/periodicity: 2 years.
* Comments: Data refers to full coverage of Central region only (28 municipalities). North has screening in two districts and South in three and two partial screenings. Population programmes in accordance with the European Guidelines for Quality Assurance Mammography Screening.   

Slovak Republic

General Health Insurance Company.
* Data represents mammography screening among women insured by the General Health Insurance Company (60 to 68 % of the Slovak population is insured by the General Health Insurance Company).

Spain

* Data not available.

Sweden

Swedish Regional Cancer Screening Programme.
* Population: Regional.
* Age variation: 50-74 years old.
* Programme or survey: programme.
* Recall period/periodicity: 2 years.
* Comments: Regional in the county of Östergötland. Programme for women ages 50-74. Some county councils have programs starting at 40.

Switzerland

* Data not available at the national level.

Turkey

Department of Cancer Control, Ministry of Health.
Mammography screening survey data:
* Cover all individuals, who apply to all public and private health care facilities except for KETEMs in Turkey. 35-69 age group is included in the calculation. This section calculates the percentage of mammography screening 35-69 aged women, who have applied to a health care facility such as a public or university hospital for any complaint. A study or survey question, as described by the OECD, is not available.
Mammography screening programme data:
* Percentage of the mammography screened in KETEMs. 50-69 age group is included in the calculation. Cover individuals, who have only applied to KETEMs. While only opportunistic screening was available until 2009, community-based organized screening has been available from after 2009. The calculations currently available (0.7%, 0.85% and 0.86% in 2006, 2007 and 2008) are based on the data obtained from 55 KETEM centers as of late 2008. It is considered that both the launch of community-based organized screening and that 84 centers are operational as of 2009 would outstandingly increase the figures in the next years.
* KETEM centers (Early Diagnosis, Screening and Training Center for Cancer) is based on the principle that "Early Diagnosis Saves Life!” and conducts screening programs for breast, cervical and colorectal cancers. As of late 2008, 84 KETEM centers were available in 84 provinces across Turkey but only 55 of them are operational. Physicians, nurses, midwives, X-ray technicians and medical technologists, who are trained in cancer protection and screening methods, are employed in these centers. Personnel are also trained in inter-personal communication and health education. For cervical and breast cancers, women are invited to the centers (via phone calls, postal services etc.). Then, they are examined and screened. All activities under screening are free of charge. The most important goals of KETEMs are raising public awareness for cancer and informing persons of protection methods and screening programs by face-to-face trainings.

United Kingdom

Department of Health, Welsh Assembly Government, Office for National Statistics
NHS Breast Screening Programme .
* Population: National, full population.
* Age variation: 50-64 years old.
* Programme or survey: programme.
* Recall period/periodicity : 3 years.
* UK coverage.
* 2007: UK data supplied from Social Trends 39, Table 7.9.

United States

National Center for Health Statistics: 2000, 2003, 2005 National Health Interview Survey Sample Adult Data file (unpublished data). For further information, please visit the HIS website: http://www.cdc.gov/nchs/nhis.htm.
Coverage: National Representative Sample of the U.S. Civilian Non-Institutionalised Population, females aged 50-69 years.
Periodicity: Recall periodicity: 2 years (Data collected 2000, 2003, 2005).
Deviation from the definition: Data does not match OECD definition.
* Numerator: Number of women aged 50-69 years old reporting having received a mammogram two years ago or less.
* Denominator: Denominator excludes respondents (females aged 50-69 years old) who reported “Refused”, “Not ascertained”, or “Don’t know” to the question “Have you ever had a mammogram?”.
* Deviation from the calculation method: Calculation methods match OECD definition. The measure is percent of women 50-69 years who have had a mammography within the preceding 2 years.
* Break in time series: No breaks in time series.

                                         

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Source OECD HEALTH DATA 2009, June 09	Last update: 06/15/2009