Performance of Mammography Screening in the National Breast Cancer Screening Program - A retrospective cohort study

Breast cancer is the second most common cancer in the world, and by far the most frequent cancer among women with an estimated 1.67 million new cancer cases in 2012 (25% of all cancers).

The incidence of breast cancer is increasing in most regions of the world; between 2008 and 2012, breast cancer rates increased by more than 20% and mortality rate increased by 14% over the same period. Incidence rates remain highest in more developed regions, but mortality is relatively much higher in less developed countries due to lack of early detection and access to treatment facilities.

Based on MoH Annual Report 2013, non-communicable diseases are among the five top leading causes of death and cancer was ranked the second. In 2012, the incidence of cancer was 64.2 per 100,000 in West Bank and 63 per 100,000 in Gaza Strip.

Breast cancer ranked first among deaths from cancer among women in both the West Bank and the Gaza Strip, where 22% (95/437) and 27% (82/306) respectively of cancer deaths were due to breast cancer.

WHO recommends earlier detection and access to treatment at an early stage, and accordingly, the Palestinian Ministry of Health (MoH) introduced free mammogram screening (an early detection method) for women aged 40 and above and younger women at high risk; during the period of 2008-2009 in the West Bank and 2010 in Gaza Strip.

The overall objective of this study was to examine the performance of the national mammography screening program in West Bank and the Gaza Strip. To do so, PNIPH tracked abnormal screening results in 2011 for health outcomes. Data was collected from mammogram registries in the 12 districts primary health care clinics in West Bank; MoH clinics in Gaza Strip; Cancer and Death registries at the Palestinian Health Information Centre (PHIC); Referral Department at MoH, interviews with all mammography technicians and supervisors; MoH doctors/radiologists; and follow-up calls with all women with abnormal screening results.

Study Recommendations:

• Developing screening mammography protocols for referrals of suspected cancer cases
• Improving infrastructure
• Reviewing medical records and mammography registry
• Training existing practitioners and additional physicians /radiologists
• Extracting diagnostic cases from primary health care for timely referral to secondary health care facilities
• Improving the completeness and quality of the Cancer Registry by improving communications between surgeons, oncologists, and pathologists to determine the stage of cancer
• Ensuring that cancer cases are notified
• Improving the public education component in the current national screening program in line with WHO recommendations on appropriate widespread coverage of high-risk groups.


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