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Table 3 Final list of candidate performance indicators

From: Monitoring and evaluation of breast cancer screening programmes: selecting candidate performance indicators

Indicator Definition Conceptual framework domain Indicator interpretation
1. Screening coverage NUMERATOR: n° of women screened
DENOMINATOR: n° of eligible (or target) women within a given period
Clinical effectiveness Facilities/resources/workforce
Personal empowerment and experience
Measures the test coverage in the population. It should primarily be used for organised screening, but it can also include tests performed in the opportunistic setting. The aim is to maximise the value of the indicator, but it can only be applied to ages for which a strong recommendation for breast cancer screening has been given.
2. Participation rate NUMERATOR: n° of women screened DENOMINATOR: n° of women invited Clinical effectiveness
Equity
Personal empowerment and experience
The aim is to maximise the value of the indicator, but it can only be applied to ages for which a strong recommendation for breast cancer screening has been given.
3. Recall rate NUMERATOR: n° of women undergoing further assessment for medical reasons based on a positive screening examination (either on the same day as screening or on recall)
DENOMINATOR: n° of women screened
Clinical effectiveness Facilities/resources/workforce Directly and timely measure the assessment workload and indirectly measure the false positive rates since cancers are a minority of recalls. High values indicate high false positive rates and should therefore raise concern.
4. Breast cancer detection rate (4a: initial and 4b: subsequent screenings) NUMERATOR: n° of cancers screen-detected
DENOMINATOR: n° of women screened
Clinical effectiveness Indirect measure of screening sensitivity. Influenced by the underlying incidence and is higher in the prevalence (first) round. Geographical comparisons and trends should take into account these two determinants.
5. Invasive breast cancer detection rate NUMERATOR: n° invasive screen-detected cancers
DENOMINATOR: n° of women screened
Clinical effectiveness Same as for the breast cancer detection rate.
6. Cancers > 20 mm NUMERATOR: n° of invasive cancers > 20 mm screen-detected
DENOMINATOR: n° of women screened
Clinical effectiveness Diameter is a strong prognostic factor. Screening should act by reducing incidence of large cancers. A reduction in the proportion of large cancers is expected in women that have been already screened. Proportion during prevalence (first) round can be considered only to set a baseline, not to measure effectiveness.
7. Cancers ≤ 10 mm NUMERATOR: n° of invasive cancers ≤10 mm screen-detected
DENOMINATOR: n° of invasive cancers screen-detected
Clinical effectiveness Indirect indicator of screening sensitivity. Reduction of the proportion of small screen-detected cancer among already screened women can be an early sign of loss in sensitivity. It is lower in the prevalence (first) round.
8. Lymph node status NUMERATOR: n° of node-negative cancers screen-detected
DENOMINATOR: n° invasive cancers screen-detected
Clinical effectiveness Lymph node status is a strong prognostic factor. Screening showed efficacy in reducing the incidence of lymph node positive cancers. Furthermore, lymph node status influences the choice of treatment determining the use of chemotherapy or not in some cases.
9. Interval cancer rate NUMERATOR: n° of interval cancers DENOMINATOR: n° of screened negative women at the last screening round Clinical effectiveness Direct measure of screening sensitivity. Influenced by the underlying incidence and the screening interval.
10. Episode sensitivity NUMERATOR: n° screen-detected cancers DENOMINATOR: n° of all cancers detected Clinical effectiveness Direct measure of screening sensitivity. May be influenced by screening round, overestimating sensitivity during prevalence (first) round.
11. Time interval between screening and first treatment Median number of days between screening and start of first treatment (10th percentile - 90th percentile) Clinical effectiveness, Facilities/resources/workforce
Equity
Measure the ability of the organisation to minimise the time required to identify, assess and treat cancers. Directly associated with women’s anxiety and, for extreme screening intervals. May reduce effectiveness because of cancer progression.
12. Benign open surgical biopsy rate NUMERATOR: n° of women found not to have invasive cancer or DCIS after an open surgical biopsy
DENOMINATOR: n° of women screened
Clinical effectiveness
Safety
Direct measure of undesirable effects. Even if some of the benign lesions are treated because of their risk to progress to cancer.
13. Mastectomy rate NUMERATOR: n° of women with mastectomy
DENOMINATOR: n° of women screened
Clinical effectiveness
Safety
Direct measure of the impact on treatment invasiveness. Identifying cancer at earlier stages should allow more conservative treatments.