Slide 1

www.screeningbc.ca SCREENING MAMMOGRAPHY PROGRAM Screening Mammography in 2014: Still Controversial? Dr. Christine Wilson MEDICAL DIRECTOR, SCREENING MAMMOGRAPHY PROGRAM BC CANCER AGENCY

Slide 2

www.screeningbc.ca Faculty/Presenter Disclosure Faculty: Christine Wilson MD Relationships with commercial interests: Medical Director Screening Mammography Program of BC (www.screeningbc.ca/breast)www.screeningbc.ca/breast

Slide 3

www.screeningbc.ca Background SMP QM practices Controversies Overdiagnosis Breast density Informed Decision Making Breast Cancer Screening

Slide 4

www.screeningbc.ca There are 4 population- based screening programs in BC: Screening Mammography Program (SMP) Cervical Cancer Screening Program (CCSP) Colon Screening Program Hereditary Cancer Program (HCP) Organized Screening Programs

Slide 5

www.screeningbc.ca Screening Mammography Program TARGET POPULATION: Women age 50-69 years Service also available to women age 40-49 & 70+ SCREENING TEST:Two-view screening mammograms offered across BC RESULTS:Screen read by a radiologist Results mailed to both patient and her health care provider REMINDER:Mailed to patient when time to re-screen STATISTICS There are 37 centers and 3 mobiles that perform screening mammography in BC 285,000 mammograms are performed annually 7.5% or ~ 21,400 patients are referred for further investigation Every year, approximately 1,400 cancers are found by screening 81% of cancers are found in women age 50 and over Participation rate for ages 50-69 is about 52%

Slide 6

www.screeningbc.ca Screening Mammography Program Screener QA process initial 2 years of clinical experience and read 2500 mammograms 40 hours of Category 1 breast imaging credits in past 5 yrs Attendance at 2 formal mammography training courses of 2 to 3 days duration with a screening mammography component at least one within past 3 yrs Pass a standardized test of 100 cases

Slide 7

www.screeningbc.ca Screening Mammography Program Screeners QA process ongoing Read a minimum of 2500 cases per year Attend an annual conference in breast imaging (SMP Forum every other year)

Slide 8

www.screeningbc.ca Screening Mammography Program Screeners QA process ongoing Statistics kept on abnormal call rate, cancer detection rate, PPV, sensitivity and specificity and given to each screener annually All are expected to maintain benchmarks: Standardized cancer detection rate > 5/1000 Proportion of early stage cancer >60% (DCIS & IDC

www.screeningbc.ca SMP Performance vs Canadian Standards Women 50 - 69 National Standards BC Abnormal Call Rate First Screens3.0/10003.9 Inv Tumour size 25%35% Inv Tumour size 50%62% Node ve Cases of Inv Ca>70%78%

Slide 10

www.screeningbc.ca SMP Performance vs Canadian Standards Women 50 - 69 National StandardsBC Diagnostic Interval No biopsy>90% in 5 weeks81.3% Biopsy>90% in 7 weeks63.6% Benign Core Biopsy Rate/1000 First Screens26.4/1000 Subsequent Screens6.3/1000 Benign/Malignant Core Biopsy First Screens5.6/1000 Subsequent Screens1.6/1000 Benign/Malignant Open Biopsy First Screens