European Reference Centre level EUREF certification was successfully achieved for each of the five German RCs regarding their professional,
technical,
training,
leadership and organisational performance.
Recommendations from the earlier visits had been implemented and resulted in recognizable improvements of service quality.
A uniform assessment protocol based on best practice had been implemented by the directors of the RCs.
To enforce adherence,
regular review of assessment cases of screening units by the RCs had been integrated into the screening directives.
Data collection and monitoring is performed on a restricted set of aggregated data.
Adaption of reporting times as well as age specific data collection enabled an improved assessment of the screening unit’s performance and outcomes.
Structural and organizational requirements:
The directors of the RCs and their staff are highly committed,
without exception,
to set up,
run and continuously monitor their screening organisation.
All RCs have specialized training programmes for radiographers and radiologists and are organising a large number of courses yearly for these professionals.
All RCs and their attached mammography and assessment units have good siting,
environment,
adequate space,
and facilities.
Outcomes of the German breast cancer screening programme 2014:
The overall results of the screening programme in 2014 were very satisfactory and largely in line with European standards.
A robust recall rate of 3.0% and breast cancer detection rate of 5.4‰ corresponding to 2.0 x IR (background incidence) was achieved for subsequent screens.
Only the participation rate of 54% did not meet the recommended level (70%) and was slightly lower than in the previous three calendar years [2].
Compared to the tumour stage distribution within the targeted population 2000-2005,
the screen-detected breast cancers in 2014 show the expected shift towards smaller invasive carcinomas at diagnosis,
see figure 3 [2].
A recent German trend analysis of tumour stage rates of breast cancer among women aged 50-69 years shows a decline in advanced stages (UICC stages II and III) after the full implementation of the programme,
confirming the impact of the programme on a prognostically more favourable tumour stage distribution among the targeted women,
see figure 4 [3].
Review of interval- and T2+ screen-detected cancers:
During the certification visits a total of 475 interval cancers and 135 T2+ cancers were reviewed.
Review of interval cancers is by its nature subject to inter-,
and even intra-observer variability.
Therefor it should be performed in a team and based on consensus.
The most important function of an external review is to ensure that the methodology and recording of results clearly demonstrates the desire and honesty of the home units to learn and correct.
In the case of every RC comparison of review method and results was satisfactory.
Mammographic image quality review:
Following the recommendations of the advisory visit,
further attention had been given to image quality and nominating supervising radiographers in each RC.
At the three types of certification visits,
(advisory-,
pre- and final-) in total more than 1,000 mammograms were reviewed.
Based on the findings it is judged that the clinical image quality of mammograms in the German breast screening programme meets the required standard for a high-quality population-based service.
Physico-technical quality control:
The physico-technical quality control programme consists of annual constancy tests and monthly/daily quality control to check system stability,
equivalent to the European protocol for the quality control of the physical and technical aspects of mammography screening,
Part 1: Acceptance and constancy testing [4].
The physico-technical quality control of the German screening programme is of a high standard,
well organized,
and has a high level of professionalism.
Results of testing are well within desirable values,
see figure 5 [5].