Plans and preparations for the mammographic screening in Slovenia

Introduction: In Slovenia there is no population based breast cancer screening, but women can attend „preventive“ mammography in a diagnostic setting. However, the opportunistic screening without quality assurance and control is not giving satisfactory results. The basic epidemiological parameters, such as the proportion of localized cancers diagnosed, breast cancer survival and mortality rate have not been improving sufficiently over the last ten years. The number of screened women is not known, but from several studies it is evident that the proportion of women in the age group 50–69, where the screening is most effective, is low, screening intervals are too short and usually women who attend the opportunistic screening are too young. Clinical examination is still part of screening exam. As well as in most European countries, also in Slovenia breast cancer ranks first in terms of cancer-related morbidity and mortality and since demographic trends have shown a steady increase in this important public health-care problem, a well-organized breast cancer screening according to European guidelines is due to start in December 2007. Together with the effective diagnostic procedures and optimal treatment it is supposed to reduce the current mortality rates due to breast cancer and the burden of this disease in the Slovenian population. Organization: High-quality organization of a screening programme is essential for early detection of breast cancer and reduction of mortality due to this disease. The key elements of a high-quality screening programme for breast cancer include the appropriate education and training of all personnel involved in the screening procedure. Specialization, multidisciplinary team working, the use of set targets, performance indicators and audit, appropriate technical quality of mammography machines and setting of an adequate information system are just some of the requirements a screening programme should fulfill. In addition to all of the above, the target population of women needs to be selected for screening mammography in an organized and systematic manner and an appropriate response rate in this population must be achieved. The target population in Slovenia counts 243.243 women, aged between 50 and 69 years, so each year around 120.000 women will be invited for a screening test. The basic organizational and functional element in breast cancer screening is the screening unit, which cooperates very closely with diagnostic unit professionally as well as functionally. Our screening programme will use digital mammography machines which will be placed in two stationary screening units in Ljubljana and Maribor, and in six mobile units, all together covering the entire Slovenia. Each mobile unit will have the capacity between 12.000 to 15.000 mammograms per year. Each mammogram will be read by two readers and in case of discordance in BIRAD results the picture will be assessed at the consensus conference where the two readers and the lead radiologist would make final decision about the screening result. All women with suspicious mammograms will be invited for further assessment at the diagnostic center, where also the treatment of all screen detected cancers will take place. Conclusions: Slovenia will start a population based breast cancer screening programme with all elements required to fulfill the European guidelines for quality assurance in breast cancer screening and diagnosis in December 2007. Breast cancer screening programme will cover the entire country within few years. Women between the ages of 50 and 69 will be invited for screening mammography every two years with an invitation letter where the date and the place of a screening test will be stated. The quality control indicators will be monitored and reported by the Register and programme Dora, Epidemiology and cancer registry department at the Institute of Oncology Ljubljana, Slovenia.