Abstract

Breast cancer is the most common malignancy among women in Estonia. A nationwide 5-year breast cancer screening programme in Estonia started in 2002. Aim of the study was to increase the proportion of breast cancers detected in the early stages. The long-term aim of the study was to obtain the information allowing to reduce mortality due to breast cancer.
Methods. The target group of screening represented women aged 45–59 years (starting from 2006, age of the target group 50–59) with a valid health insurance, participation being free of charge. In 2002 women were encouraged to participate in screening through mass media. In 2003 personal invitations were introduced, self-referrals continued to be accepted. In 2004 the screening programme became strictly invitation- only. Invitations are sent every year to certain birth year cohorts. For each year of the current 5-year programme, the Health Insurance Fund has allocated a certain amount of money that enables to screen a corresponding segment of the target population. Planning was complicated, because it depended on participation rate. The lower the participation, the higher has to be the number of invitations sent out to guarantee the target number of women to be screened. The two-year interval, essential for an organized screening programme, was not achievable till 2005 because of the financier’s demand to guarantee  equal access to the screening tests for all women in the target age group. In 2006, 4 year cohorts were invited for the second screening round.
Results. During 5 years 94 139 women were screened. In 2002 all women participated on a self referral basis. In 2003 58% of the screened women participated with invitations and 42% participated on a self-referral basis. Starting from 2004 the project became invitation based. The recall rate decreased from 5.9% (2002) to 2.18% (2006). During 5 years altogether 454 breast cancers were diagnosed by screening, while 343 (75.5%) of them were in the early stages (0–IIa).
Conclusion. During 2002–2006 an average of 75.5% of the cancers detected by screening were in the stages 0–IIa. Before the beginning of the screening project, only 39.3% of the breast cancers diagnosed in Estonia were in the early stages. The average participation rate of the invited women remained low, but increased from 37% (2003) to 51% (2006). Due to limited resources, the methodology for the organized screening programme was implemented step by step. The rate of cancer detection rate is high. The detection of early breast cancer is increasing; the recall rate for assessment is decreasing. The two main problems in screening in Estonia are low participation rate and the lack of an accurate centralized database.