Evaluation of breast cancer screening programmes: Candidate performance indicators and their association with breast cancer mortality

Aim: Evaluation of a breast cancer (BC) screening programme is necessary to ensure its quality. Performance measurements might be prioritized considering the association with outcomes related to BC mortality. We piloted an approach to explore the association of selected performance measurements with incidence-based BC mortality (IBM). Methods: We performed an ecological analysis of aggregated data from regional or national population-based cancer registries and BC screening programmes in Europe, using 13 performance indicators. We built a panel data (longitudinal cross-sectional) regression model to estimate the association between screening performance measurements and IBM rates. Results: We included data of 9 programmes and registries from Italy, Spain, Norway, Ireland and the Czech Republic. The number of screening years included in the dataset ranged from 5 to 20 years. In adjusted panel analyses, higher screening coverage, breast cancer detection rates (BCDR prevalent and subsequent rounds), node-negative proportion, and episode sensitivity were associated with lower incidence-based mortality (IBM), whereas a higher interval cancer rate was associated with higher IBM. The association for recall rate in subsequent examinations was small and imprecise. Conclusion: Our pilot approach suggests association of several performance indicators with IBM. These indicators were related to the implementation of the screening programme (screening coverage), sensitivity (BC detection rate), and efficiency (recall rate). Further studies with larger datasets and individual data may confirm these findings.