Breast cancer screening in Canada: a review.

Organized screening for breast cancer in Canada began in 1988 and has been implemented in all provinces and 2 of the 3 territories. Quality initiatives are promoted through national guidelines which detail best practices in various areas, including achieving quality through a client-service approach, recruitment and capacity, retention, quality of mammography, reporting, communication of results, follow-up and diagnostic workup, and program evaluation; it also offers detailed guidelines for the pathological examination and reporting of breast specimens. The Canadian Breast Cancer Data Base is a national breast cancer screening surveillance system whose objective is to collect information from provincial-screening programs. These data are used to monitor and evaluate the performance of programs and allow comparison with national and international results. A series of standardized performance indicators and targets for the evaluation of performance and quality of organized breast cancer screening programs have been developed from the data base. Although health care is a provincial responsibility in Canada, the collective reporting and comparison of results both nationally and internationally is beneficial in evaluating and refining both screening programs and individual radiologist performance. The results of Canadian performance indicators compare favourably with those of other well-established international screening programs. There are variations in performance indicators across the provinces and territories, but these differences are not extreme.