Breast cancer screening statistics
From Statistics Explained
Data from EHIS WAVE I (collection round 2008 data - published in April 2012). Most recent data: Further Eurostat information, Database.
Cancer of the breast is one of the most common types of cancer among women worldwide. In 2009, the standardised death rate of breast cancer for the EU-27 stood at 23.1 deaths per 100 000 inhabitants. The risk of breast cancer increases with age, family cancer history, unusual hormonal and reproductive factors, unhealthy life style and many other factors. There are three forms of breast examination: a mammogram (X-ray of the breast by a specialist), a clinical examination of the breast (by a doctor or a nurse to look for changes or lumps) and self-examination of the breast. This statistical article focuses on mammographic screening in selected European countries.
Main statistical findings
Breast cancer in health policy
In 2003, the European Parliament (EP) adopted a Resolution (A5-0159/2003) to combat breast cancer and stated that '…Every woman should have access to high-quality screening treatment, and any disparities in access should be minimized….' Apart from other calls on Member States, the EP also sought then to reduce mortality from breast cancer by 25 % and the disparity rate by 5 % in European Union countries and this to be achieved by 2008. It also promoted the provision of breast cancer screening for all women aged 50-69 years every two years.
The breast-cancer screening programmes are required to abide by European Guidelines. In 2006, the European Commission published the 4th edition of the European Guidelines for Quality Assurance in Breast Cancer screening and organization of diagnosis. The aim of the Guidelines is to put in place recommended standards and procedures for implementing breast screening programmes in the European Union, as well as ensuring the quality of breast cancer services outside of those programmes. The Guidelines also include a list of performance indicators, including promoting the proportion of women invited to attend screening, which should be between 70–75 % of eligible women in European countries. The European Guidelines are not binding, and it is up to the Member States to decide how those standards are to be incorporated into national or regional systems.
Women aged from 50 to 69 are usually called to undergo a mammogram every two or three years. Any woman who has reached the age of 53 should have had at least one mammogram by then. Nowadays there is a growing tendency to extend screening activities for the remaining age groups, i.e. those aged less than 50 and women over 69. Breast cancer screening by mammography is very costly. This might have an impact on the availability of mammography units in some countries.
Data collected from European health interview survey
First data from European health interview survey (EHIS) Wave I were published in Eurostat website in December 2010. Few graphs based on breast cancer screening variables are set out here. EHIS only asks for a breast cancer screening that is carried out by mammography (=mamma (breast) + graph (picture)). Seventeen countries sent micro data to Eurostat. Some aggregated data were received from Denmark and Germany. In the United Kingdom, only administrative data for England are available and figures are based on the report Breast Screening Programme, England 2010-2011. The reference years for the 17 countries in the EHIS survey vary (Table 1). Most of the countries launched the survey in 2008.
Figures 1 and 2 show the percentage of women who have ever undergone an mammography. Figure 1 shows the women aged between 50 and 69. Among the countries studied, France has the highest proportion (92.9 %), followed by Spain (92.3 %), Austria and Germany (90 %), Belgium (89.5 %) and Hungary (86.9 %). The proportion of women who underwent screening was lowest in Turkey (28.1 %) and Romania (13.5 %). In England the data of 2009 show that 76.5 % of all eligible women aged 50-70 had undertaken examination within the last 3 years.
Figure 2 shows data for women under 50. Among the countries studied, Greece is top of the list with nearly 38 %, followed by France (37.2 %) and Belgium (34.2 %). As in Figure 1, Turkey and Romania account for the lowest share, with less than 10 % of women undergoing a mammography.
In line with the recommendation to undergo a mammography every two or three years, Figure 3 shows the percentage distribution of the mammography for women of all ages (starting 15+) who had ever undergone the examination within either the past 12 months either in more than one year, but not more than three years or in 3 years ago and more. For many countries Figure 3 illustrates large proportions of mammography within one year or three years.
Under the EHIS survey, if a woman had ever undergone a mammography, she was also asked what her reasons for doing so were.Figure 4 shows the largest percentage of all women (15+) who were invited by national or regional screening programmes were in Hungary (55.1 % invited by programme) and Spain (43.5 % by programme). The lowest share below than 5 % participation was in Malta (only 3.6 % by programme meanwhile 96.4 % by other initiative) and Slovak Republic (1.2 % invited by programme and 98,9 % by other initiative). In England, from all women screened, 94.7 % were invited by screening progamme during 2009-2010. There were no declared cases of women having been invited as part of the national screening programme in Latvia. In Latvia the EHIS survey was launched in 2008 meanwhile the national breast cancer screening programme was implemented one year later, in 2009.The variable asking for a reason of mammography was not included in the survey in France and Austria. Austria runs since 1974 opportunistic screening: examination is conducted in non-dedicated mammography screening centers without active invitation neither control system . In Denmark a national screening programme was introduced in 2007 meanwhile the Health interview survey was launched in 2005. In Greece, national breast-cancer screening programme was not implemented yet and some pilot projects run since 1988. In Slovak Republic preparatory steps for an implementation of a national breast-cancer screening programme began in 2008.
For a number of countries, there are differences in having mammography by educational status. Figure 5 shows the percentage distribution of women aged 50-69 years ever screened by mammography, by educational status. The first category (ED0-2) represents those women having ‘pre-primary, primary or lower secondary education. The next category (ED3_4) covers those with an ‘upper secondary or post-secondary non-tertiary education’ and the last category (ED5_6) includes those who have completed the ‘first or second stage of tertiary education’. The gap between the top category and bottom categories is very large in Turkey and Bulgaria. It is especially marked in Turkey where participation in mammography among women aged 50-69 with the highest educational status (ED5_6) is 73.2 %, while for the lower educational status (ED0-2) it is only 23.9 %. There is a difference of more than 20 % between the top and bottom educational levels in Czech Republic, Romania, Latvia, Poland, Greece and Slovenia. Spain, France and Belgium have the lowest inequalities by educational level.
Figure 6 is similar to Figure 5 with the difference that the inequalities are shown by income quintile. For this illustration the first quintile (Q1) and the top fifth quintile (Q5) were used. The biggest discrepancy between income quintiles is in Latvia (73.5 % participation for the highest income group in contrast to 36.7 % for the lowest income group) and Turkey (48.5 % participation for the highest income group and only 15.3 % for the lowest income group). Participation rates in Austria and Spain are fairly good and can be considered satisfactory. Inequality is the lowest in Romania but here general participation levels for both categories are also the lowest from all the countries studied. Inequality is also very low in the Czech Republic where the participation rate is around 70 % for both categories (Q1 = 69.4 %, Q5 = 72.2 %).
Finally, information about the type and onset of breast-cancer screening programmes (essentially including mammography) in the countries studied is provided in Table 2. The timelines vary between countries and between regions within countries. There are also different types of programmes: population-based and non-population based programmes, regional and national programmes and programmes that can be said to follow (or not follow) European Union standards (European Guidelines). To give a better overview of the countries studied, Table contains only information when national or regional screening programmes began (regardless of whether EU standards were followed or the programme covered the whole population).
Data sources and availability
Notes in reference to Table 2
- In Austria since 1974 runs the “opportunistic” screening, i.e. screening is made by non-dedicated mammography screening centres and has no active invitation system. An organized and controlled breast-cancer screening programme is planned for women 50-69 years aged. Source: Department of Epidemiology, Center of Public Health, Medical University of Vienna.
- Two independent pilot projects were launched in 1996-2000 and 2000-2001.
- In Estonia first pilot started in Tallinn 1996 and in 1998 in Tartu. Source: Estonian Cancer Society.
- France Regional screening started in 1989. National screening started in 1994 covering some parts of France.
- Pilot programme implemented as part of the “Close the gap” programme having 10 screening centres in Hungary, Source: National Public Health and Medical Officer Service.
- In Poland in 1993-1995 and 2000-2002 were 2 ad-hoc organised opportunistic screenings covering only one Warsaw district. Source: Cancer Center and Institute Of Oncology
- In Slovenia, the breast cancer screening is called DORA. It does not cover the whole country, but it is planned to do so.
- In Slovak republic breast cancer screening was legislatively regulated in 2004. Since 2008 preparatory steps for an implementation of national screening programme began. Source: Onkologický ústav sv. Alžbety.
- In Romania in were launched small local early detection projects. National breast cancer screening programme did not start yet (situation to June 2012). The Ministry of Health is currently implementing a national training programme for specialised medical staff in charge of breast cancer screening. Source: Romanian Cancer Society.
- Pilot projects in Sweden started in 1982.
- Extension of the age group 50-70 began in 2001.
European health interview survey - collection round 2008 (Eurostat website: hlth_ehis)
Causes of death statistics (Eurostat website: hlth_cdeath). Table 3 contains the standardised death rate per 100 000 inhabitants for selected countries in 2009.
Further Eurostat information
- Public health (hlth), see:
- European health interview survey (EHIS) - collection round 2008 (hlth_ehis)
- Health care - collection round 2008 (hlth_ehis_hc)
- Breast examination by X-ray by educational level among women 50-69 (%) - collection round 2008 (hlth_ehis_hc2)
- Health care - collection round 2008 (hlth_ehis_hc)
- Causes of death (hlth_cdeath)
- Causes of death - Standardised death rate (per 100 000 inhabitants)(hlth_cd_asdr)
Methodology / Metadata
- European health interview survey (EHIS) - collection round 2008 (ESMS metadata file - hlth_ehis)
Source data for tables and figures (MS Excel)
- European Breast Cancer Network (EBCN)
- European Cancer Organization (ECCO)
- European Cancer Observatory
- European Commission DG Health and Consumers - Public health - Cancer
- European Network of Cancer Registers (ENCR)
- European Reference Organization for Quality Assured Breast Cancer screening and Diagnostic Services
- European Society of Breast Cancer Specialists (EUSOMA)
- Health at a glance 2012, European Commission - OECD
- International Agency for Research on Cancer (IARC)
- International Cancer Screening network
- World Health Organization (WHO): Programmes and Projects, Cancer
- Causes of death statistics
- Health statistics at regional level - causes of death
- Mortality and life expectancy statistics
- ↑ Eurostat database table: hlth_cd_asdr
- ↑ The standardised death rate of breast cancer in 2003 was 25.5 deaths per 100 000 inhabitants in EU-27; in 2008 this rate was 23.9. Thus there is decreased only by around 6.2% during 2003-2008 in EU-27.
- ↑ European Guidelines for Quality Assurance in Breast Cancer screening and diagnosis pdf
- ↑ Eligible women are women who should be invited by national breast cancer screening programmes.
- ↑ NHS report Breast Screening Programme, England 2010-11: In England (in April 2011) the age range was extended to include women aged 65-70. In December 2007 it was announced that the age at which women are screened would be extended again, incorporating ages of 47 and 73 years. This will ensure all women receive their first invitation for screening before the age of 50. The programme is now phasing in the extension. This started in 2010 and full roll-out is expected to be completed after 2016.
- ↑ EHIS WAVE I variable PA10: Have you ever had a mammography, which is an X-ray of one or both of your breasts? (Answers: Yes, No).
- ↑ EHIS WAVE I variable PA11: When was the last time you had a mammography (breast X-ray)? (Answers: Within the past 12 months, More than 1 year, but not more than 2 years, More than 2 years, but not more than 3 years, Not within the past 3 years).
- ↑ EHIS WAVE I variable PA12: What was the reason for the last mammography?
- ↑ Source: NHS report Breast Screening Programme, England 2010-11.
- ↑ Source: Medical University of Vienna
- ↑ Data of Germany in the first category of the educational status are not available.