Position paper: Breast cancer screening, diagnosis, and treatment in Denmark

Figures & data

Figure 1. Five- and 10-year crude overall survival of Danish breast cancer patients.

Table I. Summary of outcome measures from the two long-standing organised mammography screening programmes in Denmark.

Indicator Invitation round	1991–2008 Copenhagen	1993–2005 Funen	EU Acceptable^1	EU Desirable^1
Participation rate
First	71%	85%	> 70%^2	> 75%^2
Subsequent	62%	82%	> 70%^2	> 75%^2
Recall rate
First	6.8%	2.7%	< 7%	< 5%
Subsequent	2.8%	1.5%	< 5%	< 3%
Detection rate
First per 1000 per year	5.79	4.47	NA	NA
Subsequent per 1000 per year	3.20	2.79	NA	NA
First % of expected	4.4 X IR	4.0 X IR	3 X IR	> 3 X IR
Interval cancer rate
First per 1000 per year	0.97	1.08	NA	NA
Subsequent per 1000 per year	1.36	1.33	NA	NA
First % of expected	0.34 X IR	0.42 X IR	0.4 X IR	< 0.4 X IR
Interval/(detected + interval) %
First	0.14	0.19	NA	NA
Subsequent	0.30	0.32	NA	NA
Invasive % of screen detected	85%	88%	90%	80–90%
Node negative % of invasive screen detected	74%	68%	75%^3	> 75%^3
< 10 mm % of invasive screen detected	41%	35%	≥ 25%^3	≥ 30%^3

IR, breast cancer incidence rate in the absence of screening; NA, not available.

¹Perry et al. 2006 [10]; ²Proportion of women invited that attend for screening. Danish proportions calculated as proportion of women eligible for screening that attended for screening; ³Proportion at subsequent regular screening examinations. Danish proportions calculated as proportion at subsequent invitation rounds.

Table II National Mammography Screening Programme in Denmark. First screening round (2007–2010). Summary of indicator results calculated on a national basis.

Indicator	Standard	National Results (95% CI)
1. Glandular dose (PMMA^1 thickness at 4.5 cm)	< 2.0 mGy	Data not available^2
2. Participation in % of invited in % of target	> 75%	77.4% (77.3–77.5) 76.0% (75.9–76.1)
3. Re-invited within the specified screening interval of 2 years ± 3 months	≥ 98%	Not calculated^3
4. Recalled for assessment	< 5%	3.0% (2.9–3.0)
5. Interval cancers	< 30%	Not calculated^3
6. Invasive cancers (IC in % of IC+ DCIS)	≥ 80 & ≤ 90%	86.4% (85.3–87.3)
7. Node negative cancers	> 70%	67.4% (65.9–68.9)
8. Small cancers (tumour size ≤ 10 mm)	≥ 25%	36.4% (34.7–38.1)
9. Benign vs. malignant operation ratio	≤ 1:4	1:6.3
10. Breast conserving surgery (for IC± DCIS)	> 50%	80.2% (78.9–81.4)
11. Time to written answer (≤ 10 working days)	> 95%	71.1% (71.0–71.3)

DCIS, ductal carcinoma in situ; IC, invasive cancers.

¹polymethyl methacrylate or polymethyl-2-methylpropanoate (PMMA) is the unit used for standardised glandular dose calculation; ²Data not available in first screening round; ³Not relevant in first screening round.

Figure 2. Breast cancer incidence rates 1990–2011 in Denmark according to age. (A) The whole country except Copenhagen and Funen. (B) Copenhagen and Funen, where mammography screening was introduced early (1991 and 1993, respectively).

Figure 3. Breast cancer incidence rates 1990–2011 in Denmark according to tumour size. (A1–3) The whole country except Copenhagen and Funen. (B1–3) Copenhagen and Funen, where mammography screening was introduced early (1991 and 1993, respectively). A1 and B1: age group up to 49 years; A2 and B2: 50–69 years; A3 and B3: age group 70 + years.

Figure 4. Breast cancer incidence rates 1990–2011 in Denmark according to lymph node status. (A1–3) The whole country except Copenhagen and Funen. (B1–3) Copenhagen and Funen, where mammography screening was introduced early (1991 and 1993, respectively). A1 and B1: age group up to 49 years; A2 and B2: 50–69 years; A3 and B3: age group 70 + years.

Figure 5. Breast cancer incidence rates 1990–2011 in Denmark according to type of surgery. (A1–3) The whole country except Copenhagen and Funen. (B1–3) Copenhagen and Funen, where mammography screening was introduced early (1991 and 1993, respectively). A1 and B1: age group up to 49 years; A2 and B2: 50–69 years; A3 and B3: age group 70 + years.

Figure 6. In situ breast cancer incidence rates 2004–2011 in Denmark according to type of surgery. A: age group up to 49 years; B: 50–69 years; C: age group 70 + years.

Vejborg I, Mikkelsen EM, Schwartz W, Bak M, Lernevall A, Borg Mogensen N, et al. [Danish Quality Database for Mammography Screening]. Ugeskr Laeger 2012;174:2533.

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