BreastScreen Norway

BreastScreen Norway (Mammografiprogrammet) is a population-based, nation-wide screening program for breast cancer. The program offers biennial mammographic screening to all women aged 50-69, based on their personal identification number. The program aims to detect breast cancer at an early stage, reducing mortality from the disease and enabling less invasive treatments. As part of the EuCanScreen Joint Action, Norway’s approach might serve as a model for high-quality, evidence-based screening.

Screening participation and outcomes

Participation rate in each screening round have been stable at about 75% since start-up of the program in 1996, while 84% of the invited women have attended at least once over a ten-year period. The program has demonstrated a reduction in breast cancer mortality, with estimates of 20-30% decrease in breast cancer deaths among women invited (intention to treat) and about 40% reduction among those who have attended the program once or more (per protocol). Early detection and improved treatment are considered the main reasons for the reduced mortality.

How BreastScreen Norway works:

• – Invitation by mail: Women in the target group receive an invitation letter from the Cancer Registry of Norway, either by post or digitally, to participate in screening. The invitation includes a leaflet outlining the benefits and drawbacks of participation.
• – Appointment scheduling: The Cancer Registry send invitation letters with prescheduled time and place for examination.
• – Mammographic examination: A two-view digital mammogram is performed at designated screening units (26 stationary and 4 mobile units). The screening mammograms are independently read by two breast radiologists.
• – Follow-up for abnormal findings: If suspicious findings are detected, women are recalled for further assessment at one of the 16 breast centres in the country. Further assessment includes additional imaging and a needle biopsy if needed.
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Program structure

BreastScreen Norway involves multiple stakeholders who collaborate to ensure effective planning, performance, and quality assurance.

Key stakeholders

• – Cancer Registry of Norway: Responsible for screening invitations and negative result letters, information dissemination, managing IT systems and infrastructure, and coordinating technical quality assurance. Additional tasks include registration in a national database, monitoring, quality control and improvement, research on breast cancer and mammography screening, and collaboration with national and international experts.
• – Women in the target group: The primary focus of the program.
• – Breast centres: Responsible for screening, image interpretation, further assessment, treatment, and follow-up. Tasks include managing inquiries, coordinating invitations, performing screening examinations at dedicated units (stationary or mobile), independent double reading, organizing multidisciplinary meetings, and maintaining professional competence (affiliated to the RHAs, see next bullet point).
• – Regional Health Authorities (RHAs): Norway is divided into four RHAs, each responsible for organizing and delivering breast screening services within their region. Their responsibilities include ensuring service provision through affiliated breast centers, overseeing technical quality assurance and equipment maintenance, and managing the economic framework, including patient co-payments.
• – Mobile screening units: Operated by Vestre Viken Health Trust, these units ensure access to mammography screening in parts of Norway´s rural and remote areas.