[Safety of the patient and the Mammography Program in the Grand Duchy of Luxembourg: Care of cancers detected by mammography. Retrospective studies].

UNLABELLED: In Luxemburg, the national breast cancer mammography screening programme has been running for 18 years. The Coordinating Centre treats approximately 17,000 files a year. The Health Directorate, as promoter of the "Programme Mammographie", is obliged to provide itself with a maximum of guarantees; within the framework of its legal missions, it has to implement all the possible means in order that the whole approach assures minimal adverse effects. The technical quality of the 9 centres is at the level required by the European Guidelines for Quality Assurance in Mammography Screening and Diagnosis, 4th edition. The quality of the readings was already the subject of 2 evaluations of the performance of the readers: the mean accuracy of the first readers to detect cancers is 87%, of the second readers 97%. The mean recall rate for assessment is about 6%. The double reading assures the detection of between 15 and 21% additional cancers, depending on the years. The imaging of diagnostic assessment has been the subject of a retrospective study. Out of 392 cancers, time from assessment to diagnosis was longer then 24 months for 17 women (4%). Examples are described and reasons for negative assessment are listed. The main cause is the multiplicity of the doctors acting in the assessment process, resulting in a default of the examination synthesis and a certain lack of communication and multidisciplinary approach. More convergence in diagnostic breast assessment and a shortening of delays between screening and diagnosis, are desirable. IN CONCLUSION: The evolution towards Specialist Centres for breast cancer care answers an ethical obligation which the initiators of a public health programme have to assume, such as the organization of a high quality breast cancer screening programme.