breastscreen aotearoa an independent review - Ministry of Health

I SUMMARYSUMMARY AND RECOMMENDATIONSOn the basis of the conclusion of a recent World Health Organisation expert review of theevidence, a breast screening service is justified in a country such as New Zealand with ahigh mortality from breast cancer. Despite a number of factors that make the organisationand administration of efficient public health screening programmes difficult in NewZealand, BreastScreen Aotearoa, (BSA), is developing into a coherent well-monitorednational service.The quality of the screening process is high and it is provided in a consistent way across allLead Providers that is likely to maximise the benefit and minimise the harm. The systemsin place to safeguard against poor performance are comprehensive, and, although it is neverpossible to guarantee 100% "safety", the danger of an incident comparable to earlierscreening failures in New Zealand is remote.The principal constraint on BreastScreen Aotearoa as a whole is the lack of a nationalpopulation register and public health information system. As a result the proportion ofeligible women who are participating in the programme is unknown, although estimatesbased on census data suggest that it is still well below the 70% needed to achieve a 30%reduction in the number of breast cancer deaths.The present system for recording details of the pathology and treatment of screen-detectedcancers is inadequate, and this has so far prevented an assessment of how well the screeningprogramme is progressing towards its target of reducing deaths. This difficulty can beeasily resolved with the co-operation of pathologists and surgeons in BSA.Although all categories of staff working in many different aspects of BSA are obviouslydedicated to their work, there is opportunity for more communication between the LeadProviders, the Independent Monitoring Group and the National Screening Unit, toemphasise the fact that this is a national service and all are working towards the same aim.Although economic aspects of BSA were not included in this review, it appears to beexpensive in its use of health service resources, not least because of the numeroussafeguards to ensure its excellence. The number of lives which it is anticipated can besaved is not great and therefore it will be important in the future to keep cost-benefitconsiderations under review.3