Author: Coffey, Michael (IMS)
Last saved by: Michael Coffey
Company: NCI

International Cancer Screening Network (ICSN)
Program/Data Update - 2007-2008

Instructions
In an effort to maintain accurate, up-to-date information on the screening programs represented by countries participating in the ICSN, we are asking country participants to periodically update our records. Selected information on the status of screening programs internationally will be posted on the ICSN website.

There are 2 parts to this update. Part I covers breast cancer screening. Please review the information in this section for accuracy and completeness, and provide data or respond to questions where needed. If your country has both an organized screening program and screening that occurs outside of the organized program, your responses should reflect the structure, policies, and procedures of the organized program.

Part II covers cervical cancer screening. We have not previously requested information about countries’ cervical cancer screening programs. Please supply the requested information, or identify the most appropriate respondent who can provide the information if you are not involved in your country’s cervical cancer screening program.

Note that colorectal cancer screening is not included in this update as it was obtained prior to the May 2006 biennial meeting in Ottawa.
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PART I: BREAST CANCER SCREENING

1) 	Country:

2) 	Please describe the organization of the screening mammography program or programs in your country. (Check one box)
				
 National screening policy with national screening program implementation
	 National screening policy with state/provincial/regional screening program
	     implementation				
	 State/Provincial/Regional screening policy and program implementation	
	 Mammography registry system
	 Other: ____________________________________________________

3) 	Year in which the screening program or mammography registry system was implemented:    ________

4) 	Number of screening programs or registries you represent in the IBSN:       _________

	4a) 	Estimated number of mammography facilities in this program(s) or registry
	 	system:________

	4b) 	Estimated number of mammography units (i.e., X-ray machines) in this program(s) or registry system: _____________

5)  	Is the program or programs you represent actively screening women?    Yes	 No

	5a) If yes, please estimate the number of women screened in this program(s) in 2005: 
				         Initial: _________________
				Subsequent: _________________

6) 	Some screening programs are implemented as pilot projects, with the intention of eventually expanding the program to cover a larger geographic area and population. Is the program or programs you represent a pilot project?		 Yes		 No

	6a) 	If yes, please describe any plans to expand the pilot project: _____________________________________________________________
		_____________________________________________________________

7)	What are the age groups covered in your screening program or mammography registry, as defined in your country’s policies or guidelines for mammography screening: (check all that apply)
	 40-44			 60-64
	 45-49			 65-69
	 50-54			 70-74
	 55-59			 75 and over

8) 	What are the exceptions to this policy on age groups covered by the screening program? (Check all that apply)

	 No exceptions
	 High risk women are advised to begin screening at a younger age
	 Upon request, other age groups (either older or younger) may be screened
	 Other: _____________________________________________________

9) 	What are the detection methods in routine use in the screening program or programs? (check all that apply)

	 Screen-film mammography			
	 Digital mammography
	 Clinical breast exam (breast physical exam performed by a clinician)
	 Other: _________________________________

10) 	Which detection methods not in routine use are being evaluated as possible screening
 modalities for use in the screening program or programs? (Check all that apply)

	 Digital mammography
	 MRI (Magnetic Resonance Imaging)
	 CT (Computerized Tomographic Imaging)
	 Other: _____________________________

11) 	Which technologies are used in diagnostic follow-up of women with an abnormal mammogram? (Check all that apply)

	 Screen-film mammography
	 Digital mammography
	 Ultrasound
	 MRI (Magnetic Resonance Imaging)
	 CT (Computerized Tomographic Imaging)
	 Fine Needle Aspiration
	 Core Biopsy
	 Open Biopsy
	 Other: ________________________________________
 
12) 	Does the screening program or programs use centralized assessment centers for follow-up investigations of women with abnormal mammograms?  	 Yes		 No
	
	12a) If yes, how many assessment centers are used by the program or programs?
		_____________ 

13) 	Estimated size of the screening program’s target population:
	_______________ women	 Check here if not applicable or data not available

14) 	Participation rate (i.e., estimated proportion of the target population that is screened) in 2005 or most recent year for which this measure is available:

	______%			 Check here if not applicable or data not available

15) 	Recommended interval between routine screenings for 40-49 age group: (check one box)

	 1 year			
	 2 years 
	 Other: ____________________
	 Not applicable (this age group is not included in routine screenings)
	
16) 	Recommended interval between routine screenings for 50 and over age group: (check one  box)

	 1 year			
	 2 years 
	 3 years
	 Other: _____________________

17) 	Number of mammographic views required for each screening type: (check one box in each row)
			      One View	      Two View
	Initial screen:				
	Subsequent screen:			

	12a) 	Does the number of views required vary by the age group screened? 
			 Yes		 No

		If yes, please describe: 	__________________________________________
						__________________________________________

18) 	Is double reading is required for each screening round? (check one box in each row)

	Initial screen:		 Yes		 No
	Subsequent screen:	 Yes		 No

	18a) What proportion of all initial screens are double-read?		________%
	18b) What proportion of all subsequent screens are double-read?		________%

19)	If double reading is used in the screening program, how are discrepancies between the two readings resolved?

		 The woman is always recalled
		 Discussion between readers
		 Review by third reader
		 Review by consensus panel or committee
		 Other: ______________________________________

20) 	Which method(s) are used to recruit women into the screening program? (Check all that apply)
		 Personal invitation
		 Physician referral
		 Media advertising
		 Other: ____________________________________ 

21) 	What is the main method of recruitment? (Check only one)
		
		 Personal invitation
		 Physician referral
		 Media advertising
		 Other: ____________________________________ 

22) 	Who receives notification of normal screening mammography results? (Check all that apply)
		 Woman
		 GP, primary care, or referring physician
		 Other: ____________________________________ 

23) 	What is the procedure for notification of abnormal mammography results? (Check all that apply)
		 Woman notified by telephone
		 Woman notified by mail
		 GP, primary care, or referring physician notified by telephone
		 GP, primary care, or referring physician notified by mail 
		 Other: ______________________________________

24) 	In most cases, who pays for the screening mammography exam? (Check all that apply)
		
		 Government
		 Insurance
		 Woman receiving screening
		 Other: _____________________________________

25) 	Who funds the screening program or registry? (Check all that apply)

		 Government
		 Private foundation or organization
		 Other: _____________________________________		

26) 	Is quality assurance for screening mammography required by law?

				Year Enacted		National or subnational law?
		 Yes	º	
		 No	

27) 	Do screening mammography facilities in the program or registry undergo an accreditation process? (i.e., a process whereby mammography facilities are officially authorized, approved, or guaranteed as conforming to a described set of standards by an official accrediting body)
						
		 Yes			 No

	27a) If yes, is the accreditation process mandatory or voluntary?

		 Mandatory		 Voluntary	

28) 	Are periodic site visits made to screening mammography facilities in the program or registry? (Note: a site visit is an inspection by individuals who do not work at the screening facility. Site visits may be conducted by staff located at a central office of the screening program, or affiliated with an independent organization)

		 Yes		 No

29) 	Does the screening program or registry use a set of guidelines for mammography quality assurance?

		 Yes		 No

	29a) If yes, please indicate which guidelines: __________________________________
							___________________________________

	29b) If yes, have these guidelines been revised since 2000? 	 Yes  	 No

30) 	Is there a cancer registry in the geographic region in which the screening program or programs operates?		 Yes		 No
		
	30a) 	If yes, are cancer registry data linked to screening program data?

					 Yes		 No

	30b) 	If yes, is the linkage of cancer registry and screening program data computerized or manual (i.e., paper records)?

		 Computerized		 Manual

31) 	Which of the following performance measures does your program or registry currently assess? (check all that apply)		Note: PPV = Positive Predictive Value 

		 PPV (screening test)			 Open biopsy rate
		 PPV (additional imaging)		 Sensitivity
		 PPV (recall)				 Specificity
		 PPV (open biopsy)			 Imaging rate
		 PPV (core biopsy)			 Cytology rate
		 PPV (cytology)			 Benign biopsy rate
		 Participation rate			 Cancer detection rate
		 Recall rate 				 Benign/malignant ratio
				 Other: _______________________________

32) 	Which of the following program impact measures is your program or registry actively assessing? (check all that apply)

		 Case fatality

		 Deaths prevented
		 Quality of life
		 Cost effectiveness
		 Life years gained
		 Mortality reduction
		 Other: _________________________________

33) 	Are there other organized screening mammography programs operating in your country that you do not represent in the IBSN and therefore are not reflected in this survey response?

		 Yes		 No

	33a) 	If yes, please briefly list or describe the programs:
		__________________________________________________________________
		__________________________________________________________________
		__________________________________________________________________

34) 	For each age group listed below, please give your best estimate of the proportion of all women in the geographic area in which the screening program or programs is operating who receive screening outside of organized programs (i.e., through opportunistic screening)

	a) 40-49:     ________%			
	b) 50-59:     ________%			
	c) 60-69:     ________%			
	d) 70 & up: ________%			
		
35) 	If there are any other changes in the screening program(s) you represent, or in how screening mammography is delivered in your country, please use the space below to tell us about them:

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

36) 	Does your screening program have a Web site? If yes, please list the address for this Web site:
	_________________________________________________________

37) 	Have any papers or reports describing the results of your screening program been published within the last two years? If yes, please list them:
	_________________________________________________________
	_________________________________________________________
	_________________________________________________________
	_________________________________________________________

PART II: CERVICAL CANCER SCREENING 

1)	Does your country have one or more organized cervical cancer screening programs?

 Yes	
 No (SKIP TO END)

2) 	Please describe the organization of the cervical cancer screening program or programs in your country. (Check one box)
				
 National screening policy with national screening program implementation
	 National screening policy with state/provincial/regional screening program
	     implementation				
	 State/Provincial/Regional screening policy and program implementation	
	 Other: ____________________________________________________

3) 	Year in which the cervical cancer screening program was first implemented:    ________
 
4) 	Please estimate the number of women screened in this program(s) in 2005:       ________

5) 	What are the age groups covered in the cervical cancer screening program, as defined in your country’s policies or guidelines for screening: (check all that apply)

	 15-19			 40-49
	 20-24			 50-59
	 25-29			 60-69
	 30-39			 70 and over

6) 	What are the detection methods in routine use in the screening program or programs? (check all that apply)

	 Pap test, liquid-based cytology (specimen suspended in liquid solution)			
	 Pap test, conventional cytology (smear spread on glass slide and fixed)
	 HPV test triage
	 HPV test primary screening
	 Other: _________________________________

7) 	Which detection methods not in routine use are being evaluated as possible screening 
modalities for use in the screening program or programs? (Check all that apply)
	
 HPV test primary screening
	 HPV DNA test
	 Other: _____________________________

8) 	Estimated size of the cervical cancer screening program’s target population:
	_______________ women	 Check here if not applicable or data not available

9) 	Participation rate (i.e., estimated proportion of the target population that is screened) in 2005 or most recent year for which this measure is available:

	______%			 Check here if not applicable or data not available

10) 	Recommended interval between Pap tests for average-risk women younger than age 70: (check one box) 

	 1 year			
	 2 years 
	 3 years			
	 5 years
	 Other: ____________________

11) 	Which method(s) are used to recruit women into the cervical cancer screening program? (Check all that apply)
		 Personal invitation
		 Physician referral
		 Media advertising
		 Other: ____________________________________ 
										
12) 	What is the main method of recruitment? (Check only one)
		
		 Personal invitation
		 Physician referral
		 Media advertising
		 Other: ____________________________________ 

13)	What types of facilities does the cervical cancer screening program use to screen women? (Check all that apply)

		 Dedicated screening centers			
		 Private physician offices—general practitioners (G.P.s) 
		 Private physician offices--gynecologists			
		 Mobile screening units
 Clinic, public health center/maternal child clinic
		 Other: ____________________

14) 	In most cases, who pays for the cervical cancer screening exam? (Check all that apply)
		
		 Government
		 Insurance
		 Woman receiving screening
		 Other: _____________________________________

15) 	Who funds the cervical cancer screening program? (Check all that apply)

		 Government
		 Private foundation or organization
		 Other: _____________________________________		

16) 	Does the screening program use a set of guidelines for quality assurance of cervical cancer screening?

		 Yes		 No

	16a) If yes, please indicate which guidelines: __________________________________
							___________________________________

17) 	Has the HPV vaccine been approved for use in your country?

 Yes
		 Not yet, it is under review (SKIP TO Question 20)
		 No (SKIP TO Question 20)

18) 	What types of facilities provide the HPV vaccine?

 Cervical cancer screening centers
		 Private physician offices—general practitioners (G.P.s)
		 Private physician offices—gynecologists 
 Clinic, public health center/maternal child clinic
		 Other: _____________________________________

19) 	Does your cervical cancer screening program have a Web site? If yes, please list the address for this Web site:
	_________________________________________________________

20) 	Have any papers or reports describing the results of your cervical cancer screening program been published within the last five years? If yes, please list them:
	_________________________________________________________
	_________________________________________________________
	_________________________________________________________
	_________________________________________________________

21) 	If there is anything else you would like to tell us about cervical cancer screening in your country, please use the space below:

_________________________________________________________
	_________________________________________________________
	_________________________________________________________
	_________________________________________________________

Thank you for taking the time to update our records. Should you have any questions about this Program/Data Update form, please contact:

		Emily Dowling, MHS
		Applied Research Program
National Cancer Institute
		EPN 4005; 6130 Executive Boulevard
		Bethesda, Maryland	USA	20892-7344
		Phone: 301/594-6654
		Fax:	301/435-3710
		E-mail: dowlinge@mail.nih.gov