Evaluation of a mammography screening program within the population-based Vorarlberg Health Monitoring & Prevention Program (VHM&PP).

Objectives: To describe the mammography screening program from 1989 to 2005 within a population-based prevention program in Austria and to appraise it according to recommended quality indicators.

Material And Method: From 01.01.1989 all women aged 40 years or older participating in the Vorarlberg Health Monitoring & Prevention Program (VHM&PP) was offered to undergo additionally a "screening mammography". Passive follow-up has been performed by record linkages with the Vorarlberg cancer registry and mortality statistics for information on outcome variables. Interval cancer rates have been estimated and the survival after breast cancer has been calculated by life table technique by examination period and age groups (40-49 years, 50-69 years).

Results: Between 1989 and 2005 50,100 women aged 40 to 69 years participated in the program, of which 123,652 mammogram results have been collected. In the target population the participation rate was 65.1%. During median follow-up time 13.5 years and 633,342 person-years overall 665 invasive cancer and 87 ductal carcinoma in situ (11.6%) cases have been identified. Between 1996 and 2004 the detection rates were 239.9 per 100.000 among women aged 40-49 years and 543.2 per 100,000 among women aged 50-69 years. The rates for interval cancers were 160.4 and 277.4 per 100 000 negative screens, respectively. During median follow-up of 13.5 years 165 deaths occurred with no difference in survival between patients with interval and screen detected cancers.

Conclusion: A mammography screening program has been performed between 1989 and 2005 in Vorarlberg. Till 2005 most quality indicators improved and met the EU-recommendations suggesting that alternative approaches to organized mammography screening based on routine data should be explored.