Practice and challenges in Assuring the Quality of Breast Cancer Care in Europe - Norway

Transcription

1 Practice and challenges in Assuring the Quality of Breast Cancer Care in Europe - Norway Solveig Hofvind Head of the Norwegian Breast Cancer Screening Program Baveno, Lago Maggiore, Italy Dec 10, 2015

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4 Causes of deaths in Norway, 2012 About 25%

5 # of physicians per 1000 inhabitants, 2013 (2012*)

6 Health costs per inhabitants, selected OECD countries, 2013 (*2012)

7 Norwegian Government of Health and Care Services Health Directorate Four Regional Health Trusts run 20 Health Trusts Hospitals - do research - education of physicans Primary Health Care Cancer Registry of Norway Part of South-Eastern Norway Regional Health Authority Organized as an independent institution under Oslo University Hospital Trust, with its own board

8 The Cancer Registry of Norway Established in 1953 Mandatory by law to notify new cancer cases to the CRN (MD, hospitals and labs) Cancer information comes from several independent sources Annually notifications related to cancer illness of these, almost new cancer cases Annual report cancer incidence About 160 persons employed Administration Registry IT Research Screening Screening Breast Cancer Screening Program Cervical Cancer Screening Program Pilot: Colorectal cancer screening

9 Age adjusted (Norway) trends in cancers,

10 Cumulative risk of developing cancer (%), Prostate

11 Two cancer screening programs and one pilot study Started in 1993 Women aged Started in 2012 Men & women aged Started in nationwide 2005 Women aged 50-69

12 Breast cancer incidence, survival and mortality, Survival Incidence Breast cancer mortality

13 Breast cancer incidence rates, 2006 (European std) Ferlay et al 2007

14 Breast cancer mortality rates, 2006 (European std) Ferlay et al 2007

15 The Norwegian Breast Cancer Screening Program 1996: Start up of a pilot (four counties) 1998: Decision to expand the program to be nationwide by the Government 2005: All women aged invited to two-view biennial screening Independent double reading (2015: 580,000 women) 2008: The Government put 12 mill NOK into an external evaluation of the program performed by external research groups 2006: Challenges according to use of the data/ informed consent A new questionnaire was taken into use 2013: Results from mortality and epidemiologic over-diagnosis analyses based on individual data available 2015: Results of the external evaluation

16 The Norwegian Breast Cancer Screening Program Norwegian Government of Health and Care Services (principle) Norwegian Directorate of Health Cancer Registry (management) National Radiation Protection Authority (technical quality control) Health trusts: Screening and follow-up

17 The Norwegian Breast Cancer Screening Program Run according to the European and Norwegian guidelines 30 screening units (26 stationary + 4 mobile) 16 breast clinics National Advisor Group Steering committee Reporting QA/Site visits Biennial meetings >150 publications from the program

18 The Norwegian Breast Cancer Screening Program 43% reduction in breast cancer mortality among those screened 28% reducion in breast cancer mortality among the invited women 37%reduction in breast cancer mortality among those screened

19 A national coordination center ensures one screening program National guidelines for Screening Treatment and follow-up All attendees offered same screening, treatment and follow-up regardless of where the screening exam is performed One quality assurance manual The same information is given to all women The same guidelines and quality assurance are performed for all labs/breast centers Nationwide register with possibilities for linkage with the incidence database (interval cancer) Common rules for implementation of new techniques One common IT network

20 National level (Cancer Registry) Administration Managing/running the program Quality assurance Invitations Identification of the women targeted by the screening program Letters IT systems and support At the Cancer Registry To / from the screening units To /from the breast centers Collection and coding of the data Ensure high quality and completeness

21 National level (Cancer Registry) Quality assurance According to the quality assurance manual Reporting to the breast centers and to the professionals Merging with other data files Information To the women targeted by the screening program To the general population To media National Advisory Board Technical and physical quality assurance Norwegian Radiation Protection Authorities? Meetings for the different professions Secretary Presenting and running projects Research Initiate and perform

22 Regional / county level Screening exam According to the guidelines Ensure and maintain high attendance rate Interpretation of the screening tests According to the guidelines (volume, time etc) Additional/recall exams, treatment and follow up According to the guidelines Quality assurance Related to the regional activity According to the guidelines Report deviations Research Regional and national projects

23 Structure and strategy for national screeningprograms in Norway Directorate of Health: November 2014 Steering groups

24 National plan of action with guidelines for diagnostics, treatment and follow-up of patients with breast cancer Utgitt: IS-nummer: IS-2316 Type: Nasjonale faglige retningslinjer

25 National guidelines - topics covered Epidemiology and Screening The progress time (from symptoms to diagnosis and treatment) Diagnostics and exposition Surgical treatment of localized breast cancer (curative) Radiation treatment of localized breast cancer Adjuvant systemic treatment Treatment of loco-regional breast cancer / recurrences Follow up after finished curative treatment Treatment of metastatic breast cancer Rare cases of breast cancer Inherited breast cancer Efforts related to treatment (physiotherapy, supplementary treatment etc

26 National quality register for breast cancer Detailed information about the breast cancer cases Pathology Surgery Oncology Radiology

27 Summary Practice and challenges in Assuring the Quality of Breast Cancer Care in Norway National guidelines for Screening Diagnostics Treatment Follow-up QA for screening Feedback, but no real action is taken if recommendations are not met