Evolution of breast cancer screening in countries with intermediate and increasing incidence of breast cancer.
BACKGROUND
Few studies have been published regarding the practice of breast cancer screening in Asian countries.


OBJECTIVE
The present study illustrates how the health policy for breast cancer screening has evolved in Taiwan from selective mammographic screening within a high-risk group, firstly to a programme of physical examination by public health nurses, and finally to a two-stage breast cancer screening programme, with a risk assessment followed by mammography for those at moderate to high risk.


METHODS
Breast cancer screening has evolved from 1995 to 2004 in Taiwan in three stages: (1) selective screening for breast cancer with mammography, ultrasound and physical examination only in first-degree relatives of breast cancer cases (1995-1998); (2) a programme of mass screening (1999-2001) with physical examination by public health nurses; and (3) two-stage breast cancer screening with a risk factor questionnaire and mammography for those deemed at moderate-to-high risk (2002-2004). The questionnaire was based on significant risk factors in a previous epidemiological study, in conjunction with the physical examination programme, a risk score was constructed from the logistic regression coefficients from the previous study, and women with a score above the median in the previous epidemiological study were assigned to mammography.


RESULTS
Two-stage mammography screening had the most favourable results compared with the two previous screening regimes. It had a positive predictive value of recall after mammography of 14%, compared with 8% for selective screening and 2% for physical examination. Of screen-detected cancers in the two-stage programme, 71% were either ductal carcinoma in situ or stage T1, compared with 61% for selective screening and 60% for physical examination. The area under the receiver operating characteristic curve was 71% for the two-stage programme.


CONCLUSIONS
For a low- to medium-risk country such as Taiwan, two-stage screening has acceptable parameters of recall and cancer detection, and compares well with other screening strategies.
Wu
Grace Hui-Min
GH
College of Public Health, National Taiwan University, Teipi, Taiwan, ROC.
Chen
Li-Sheng
LS
Chang
King-Jen
KJ
Hou
Ming-Feng
MF
Chen
Shin-Chen
SC
Liu
Tse-Jia
TJ
Huang
Chiun-Sheng
CS
Hsu
Giu-Cheng
GC
Yu
Chih-Cheng
CC
Jeng
Li-Li
LL
Chen
Shou-Tung
ST
Chou
Yi-Hung
YH
Wu
Chang-Ying
CY
Shin-Lan
Koong
K
Chen
Tony Hsiu-Hsi
TH
D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008327:Mammography / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data / Q000639:trends; D008875:Middle Aged; D015233:Models, Statistical; D013018:Sound Spectrography / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends; D011795:Surveys and Questionnaires; D013624:Taiwan / Q000453:epidemiology