Breast cancer is one of the most important causes of potential years of life lost in women in Flanders. Several international studies show a substantial decrease in cause-specific mortality when women between 50 and 69 years of age undergo a two-yearly mammographic examination. Only a minority of the target group of Flemish women, has a preventive mammography performed. On the other hand, a lot of preventive mammographies is performed in women outside the target group.
It is not surprising though, that breast cancer screening is one out of the five health targets of the Flemish Community. On the 15th of June, 2001, a Flemish breast cancer screening programme has started. By 2006, three out of four women from 50 to 69 years should have performed a preventive mammography and 80% of all preventive mammographies has to be performed within the target group.
Besides the desired shift from preventive mammographies outside the target group to preventive mammographies within the target group, a lot of attention is given to the quality of the screening programme. Women who participate in the screening programme, are guaranteed that the co-operating radiologists comply with the severe European quality criteria: physical-technical (the apparatus) as well as where positioning (the radiologist) is concerned. Women belonging to the target group can have their preventive mammography performed for free. For the organisation of the Flemish screening programme, five Regional Screening Centres (RSC) are put into action. The RSC of Antwerp, belonging to the Centre for Cancer Prevention of the Research Group Epidemiology and Community Medicine (University of Antwerp), is one of them. A RSC is a reference centre taking care of the invitations and the information for women, information for physicians concerning the results of the preventive mammography, the double reading of the mammographies, the administrative follow-up of the medical path of screening positives and the scientific evaluation of the screening programme (according to an epidemiological protocol based on European guidelines). The tasks of the RSC are formalised in an agreement with the Flemish government. A few years ago, the so-called Logo's (Local health consultation) were established. Logo's are geographical entities between province and community level which have to promote the preventive health care in their region. In Flanders, 26 Logo's operate. Each Logo has to work together with a RSC to organise breast cancer screening. The Flemish community has chosen to organise breast cancer screenig by means of two `tracks'. Women are referred by their GP or gynaecologist in the first track or directly invited to a certified radiologist by het RSC (2nd track). The certified radiologists (private, hospital or mobile unit) perform the screening mammographies. The double reading, an essential part where quality assurance is concerned, is done by the RSC. In the case of abnormal results, the diagnostics is finalised and women are treated when necessary. In the latter case, gynaecologists, radiologists, oncologists, surgeons and pathologists are involved.