Authors' objectives:

This report aims to answer the following questions:

- To what extent are reductions in the efficacy of a mammography screening programme with a participation rate of under 70% to be tolerated?

- What quality demands are to be considered as having priority?

- What experience is available concerning the application of mammography screening programmes? - Which methods have proved reliable for assuring participation?

- What status do mammography based screening programmes have in other countries?

Authors' results and conclusions: - The mammography screening effect of 30% in reducing breast cancer mortality can as a rule only be achieved with participation rates of approximately 70% and above. As, however, in many countries, so-called "unofficial" screening takes already place, whereby it cannot be assumed that the resources employed are meaningfully used, the development of an organized programme will even then be considered to be meaningful when such participation rates are not achieved. - Quality assurance of screening programmes covers the whole programme, and not only the technical procedures. Standardization recommendations related to Europe have been elaborated and are increasingly becoming more acceptable. - In applying screening programmes, a continuous and concomitant evaluation is at the very beginning an essential prerequisite for guaranteeing the contended success. The experiences in application are, however, dependent on the health political context in which the respective screening programme is being carried out, and are therefore not automatically transferable to German conditions. - Ensuring participation in such a screening programme is dependent on many factors which are influenced by locality and culture, and this has to be evaluated according to the respective context. In an international context a tried and tested method has been to motivate the potential participants through doctors they are in contact with, as well as through letters of invitation. - All countries in the European Union, apart from Germany, have at least introduced pilot projects for mammography screening, taking advantage of the support offered by the European Union. - The costs of a programme covering an extensive area are influenced by various factors, first and foremost being the incidence and mortality of the disease which is to be detected. The quality of a screening investigation, expressed in terms of sensitivity and specificity, as well as the participation rate of the target population are further parameters which have an immediate effect on the costs. It is not automatically possible to transfer foreign documents on the subject of early detection of breast cancer to German conditions. The results have mainly been obtained in health systems which are, in contrast to Germany, organized centrally.

Authors' recommendations: In 9 international, randomized studies the effect mammography sreening has in reducing mortality caused by breast cancer could be proved. Without drawing up theme related assessments of procedures and without corresponding model projects, our estimation as achieved in the decentralised German health system can only continue to be a limited one. Concepts for testing mammography screening in the framework of demonstration projects which explicitly take German conditions into consideration have been developed, and suggestions for solutions have been elaborated. It is to be expected that in connection with the agreement between the National Association of Statutory Health Insurance Physicians and the federal health insurance organizations concerning the implementation of model projects, information shall be gained about whether a screening programme covering an extensive area with an adequate cost-benefit ratio can be integrated into the structures of the German health care system. Assessments of procedures, evaluations of programmes and guidelines from foreign institutions can contribute important detailed information when implementing the planned model projects.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.dimdi.de/

Year Published: 1998

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Germany

Organisation Name: German Agency for HTA at the German Institute for Medical Documentation and Information

Contact Address: German Agency for Health Technology Assessment at the German Institute for Medical Documentation and Information, Waisenhausgasse 36-38a, D-50676 Cologne Germany

Contact Name: dahta@dimdi.de

Contact Email: dahta@dimdi.de

Copyright: German Agency for Health Technology Assessment at the German Institute for Medical Documentation and Information