Lessons Learned from the National Irish Breast Screening Program: The first 12 years

1) To review the results of the Irish National Breast Screening Program following 12 years of screening with over 1,000,000 mammograms performed. 2) To understand the essential components of setting up and maintaining a national breast screening program in Ireland. This includes the rationale for the decisions made at the outset, such as age range, frequency of screens, centralisation of service and responsibility of the screening process to the end of primary surgery. 3) To understand the need for and the mechanism of developing a national registry of eligible women in the absence of a national unique identifier. 4) To understand the need for a client charter which sets out client guarantees, objectives and goals around issues of consent, timeliness of screening results and recall to assessment, biopsy results and admission for surgery and further treatment where indicated. 5) To understand the necessity of national guidelines, annual reports and external accreditation. 6) To demonstrate the essential need for ongoing review of key performance indicators (recall rate, biopsy rate, cancer detection rate, DCIS rate, open biopsy rate, false negative rate, interval cancer rate) as surrogates of program success. 7) To understand the importance of communication and feedback to clients, units, practitioners and media in maintaining uptake. 8) To understand the reporting structure and the composition of various roles within the multidisciplinary medical and surgical teams. 9) To understand the requirements for ongoing training and education of all staff – physicians, technologists, nurses, physicists, administrative staff. 10) To understand the factors affecting radiation dose to the screened population and the over-riding responsibility of the ALARA principle, such as: role of physics team, mammographic technique, equipment choice, technologist expertise and training, quality assessment. 11) To understand the operational issues of different screening units, double reading, discrepancy cases, dealing with interval cancers, dealing with outliers in key performance parameters. 12) To understand the positive spinoff s from the program including increased awareness, improving national standards in the screening and the symptomatic population and the contribution to improved diagnostic and treatment options. 13) To understand how the program achieved, maintained, and monitored performance and how it adapted to changes in practice as issues or controversies arose. 14) To discuss whether this population screening program has been a successful and cost effective health care initiative for Ireland. 15) Ultimately, to understand whether the Irish National Breast Screening Program has led to improved survival in women with breast cancer in Ireland.

RC118B

Lessons Learned from the National Irish Breast Screening Program: The first 12 years–One Million Mammograms On