Recommendations from the European Breast Cancer Guidelines
Should an organised mammography screening programme vs. an opportunistic or non-organised mammography screening programme be used to diagnose early breast cancer in asymptomatic women?
- Strong recommendation against the intervention
- Conditional recommendation against the intervention
- Conditional recommendation for either the intervention or the comparison
- Conditional recommendation for the intervention
- ✓ Strong recommendation for the intervention
A recommendation can be strong or conditional.
When a recommendation is strong, most women will want to follow it. When a recommendation is conditional, the majority of women want to follow it but may need more discussion with their healthcare professional first.
The GDG recommends by consensus that organised screening programmes should be used over opportunistic or non-organised mammography screening programmes on both the research evidence presented and the additional considerations noted above by the GDG.
The GDG judged that the desirable effects including increased breast cancer detection were large.
The GDG judged that the undesirable effects of an organised screening programme would be trivial.
Certainty of the evidence of test accuracy:
The GDG judged that the overall certainty of the test accuracy was moderate.
Balance of effects:
The GDG judged that the balance of effects favours organised screening.
The GDG judged that organised screening would increase health equity.
Monitoring and Evaluation
EvidenceDownload the evidence profile
The GDG also notes that in organised screening there may be additional administration costs, however, the cost per examination may be lower and would vary by country.
Socio-economic inequalities (comparing highest with lowest educational level) were found in countries with opportunistic screening, but not in those with national (organised) screening programmes.
Kalecinski at al. (Kalecinski J, 2015) reported the results from a qualitative interview in 48 women from a randomly selected sample of women who were invited to attend organised breast cancer screening in 13 French departments between 2010 and 2011.
Twenty-seven women chose the organised screening programme, which they considered to be trustworthy, as negative mammograms are double checked by a second radiologist. Twenty-one women preferred individual screening, which they considered to be more reliable, less anonymous and providing them with more liberty to take control of their own health.
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- de Gelder R, Bulliard JL,de Wolf C,Fracheboud J,Draisma G,Schopper D,de Koning HJ. Cost-effectiveness of opportunistic versus organised mammography screening in Switzerland. Eur J Cancer; 2009.
- Neeser K, et al.. Cost-effectiveness analysis of a quality-controlled mammography screening program from the Swiss statutory health-care perspective: quantitative assessment of the most influential factors. Value Health; 2007.
- Schiller-Fruehwirth I, et al.. The Long-Term Effectiveness and Cost Effectiveness of Organised versus Opportunistic Screening for Breast Cancer in Austria. Value Health; 2017.