Dialogue: No serious problems in breast-screen project

Contrary to the views expressed in a Herald article headlined "Breast-screening programme lags," serious problems are not developing in the national programme, BreastScreen Aotearoa.

Nor, for that matter, does the recent independent monitoring report - number five - indicate that there are.

The report shows that all six programme providers are succeeding in the most important aspects of the programme - screening women and diagnosing and enabling treatment of breast cancer at a very early stage.

As a result, in the 18 months to the end of June last year, 814 women were diagnosed with cancer through the programme. In the same period more than 120,000 women aged between 50 and 64 were screened by the programme, of whom 8000 - or 6.6 per cent - were referred for assessment because of an abnormality detected at the time of screening.

The programme operates in accordance with rigorous quality standards and is routinely monitored by the BreastScreen Aotearoa independent monitoring group. Routine monitoring of national screening programmes is essential to ensure quality and enables identification and resolution of problems at an early stage.

For this reason, the independent monitoring group is a key component in the success of the national breast-screening programme. The reports it provides contain analysis of data that is transferred to the group every three months and are one of a number of tools that are drawn upon to develop the national programme during its still-early days of development.

The fifth report, released in December - which covers March to June 2000 - shows strong progress made against previous reports. The reports show a progressive increase in the amount of monitoring data supplied by programme providers during the first 18 months of the programme's existence.

Based on this information, the fifth report raises a concern that the national programme will not reach its target of 70 per cent of eligible women enrolled in the programme by the end of its first two years and that this could affect the two-yearly screening interval.

It is important to note that the programme has been designed with the capacity to ensure all women enrolled will receive mammograms every two years, regardless of the number of eligible women enrolled.

The national programme set ambitious targets when it began and in working toward those targets we have had enrolment rates that compare favourably with successful breast-screening programmes that have run in other countries for longer.

Although the national breast-screening programme will continue to grow in effectiveness as the number of women enrolled increases, it has already made a major impact on detecting and enabling early treatment of breast cancer for hundreds of women.

The Herald article raised the issue of 263 women referred for assessment but who had not had their results included in the national monitoring data. This point needs to be clarified. The relevant provider maintains information on the circumstances of all 263 women and regular status reports are provided to the national screening unit.

It must be reiterated that this is not an issue of women not getting appropriate follow-up. Rather, it is a limitation of the national monitoring data which will be addressed. The National Screening Unit is working with providers and the independent monitoring group to improve the transfer of this information to the group.

In time, this work will enable the group to monitor fully all aspects of the national breast-screening programme. This will set the standard for monitoring health services in New Zealand.

* Dr Julia Peters is the manager of the Ministry of Health's National Screening Unit.