Quality assured implementation of the Slovenian breast cancer screening programme.

Katja Jarm,Cveto Šval,Maksimiljan Kadivec,Maja Primic Žakelj,Barbara Gazić,Peter B Dean,Mateja Krajc,Igor Josipović,Mateja Kurir Borovčić,Kristijana Hertl,Vesna Zadnik,Urban Zdešar,Janez Žgajnar,Veronika Kutnar,Lawrence Von Karsa,Rashidul Alam Mahumud

doi:10.1371/journal.pone.0258343

Abstract

The organised, population-based breast cancer screening programme in Slovenia began providing biennial mammography screening for women aged 50-69 in 2008. The programme has taken a comprehensive approach to quality assurance as recommended by the European guidelines for quality assurance in breast cancer screening and diagnosis (4th edition), including centralized assessment, training and supervision, and proactive monitoring of performance indicators. This report describes the progress of implementation and rollout from 2003 through 2019. The screening protocol and key quality assurance procedures initiated during the planning from 2003 and rollout from 2008 of the screening programme, including training of the professional staff, are described. The organisational structure, gradual geographical rollout, and coverage by invitation and examination are presented. The nationwide programme was up and running in all screening regions by the end of 2017, at which time the nationwide coverage by invitation and examination had reached 70% and 50%, respectively. Nationwide rollout of the population-based programme was complete by the end of 2019. By this time, coverage by invitation and examination had reached 98% and 76%, respectively. The participation rates consistently exceeded 70% from 2014 to 2019. The successful implementation of the screening programme can be attributed to an independent central management, external guidance, and strict adherence to quality assurance procedures, all of which contributed to increasing governmental and popular support. The benefits of quality assurance have influenced all aspects of breast care and have provided a successful model for multidisciplinary management of other diseases.

Highlights

Breast cancer is the leading cancer site in women in Slovenia and is a major public health problem
Nationwide rollout of the population-based programme was complete by the end of 2019
The successful implementation of the screening programme can be attributed to an independent central management, external guidance, and strict adherence to quality assurance procedures, all of which contributed to increasing governmental and popular support

Summary

Introduction

Breast cancer is the leading cancer site in women in Slovenia and is a major public health problem. Each year around 400 women (39/100,000) die from breast cancer [1]. Opportunistic screening had been widely available to Slovenian women since 1990, only about 50% of all breast cancer cases were detected at a localized stage prior to the implementation of organised screening [2,3,4]. Opportunistic screening did not significantly improve earlier detection, and was associated with more operations for benign breast findings [5]. In a concerted effort to decrease breast cancer mortality rates and reduce the burden of this disease in the population, a program of systematic early detection through screening, effective diagnostic pathways, and optimised treatment with quality-assured services [6] was established

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