A new European study, published in the Breast Journal, has explored which features of breast screening programmes are most strongly linked with reducing deaths from breast cancer. The study used data from nine organised breast screening programmes in five European countries to find out which performance measures are most important for improving outcomes.
We were part of the European Commission Initiative on Breast Cancer (ECIBC) Guidelines Development Group who worked with partner organisations on this study.
Background to the research
Breast screening aims to find cancer early when treatment is most effective and survival rates are higher. It takes many years to see how much a screening programme reduces deaths. That’s why we use performance indicators to track quality and effectiveness along the way.
This research aimed to find out which indicators are most closely linked to lower breast cancer deaths - so that health systems can focus on the measures that matter most.
About the study
The authors looked at long-term data from breast screening programmes in Ireland, Norway, the Czech Republic, Spain and Italy by linking programme results with European Cancer Registry data.
We analysed 13 key measures - known as performance indicators - that show how well breast screening programmes are running. These included measures such as how many people are invited and attend, how many cancers are detected and how accurate the tests are.
We compared these indicators with incidence-based breast cancer mortality - the number of women who died from breast cancer after being invited to screening. This helps show whether better programme performance is linked to fewer deaths over time.
What the study found
The analysis found clear links between several indicators and lower breast cancer deaths.
- Higher screening coverage reduces deaths: programmes that reached more women had lower breast cancer mortality rates.
- Higher cancer detection rates help save lives: when screening detected more cancers in both first and later rounds, deaths were lower.
- Node-negative cancers were linked to better outcomes: this means cancers were found before they spread to the lymph nodes.
- Greater episode sensitivity improves outcomes: this measure reflects how effectively the whole screening process – from mammogram to diagnosis – finds cancers.
- Higher interval cancer rates were linked to higher mortality: interval cancers are those found between screening rounds, and more of these were associated with worse outcomes.
While recall rates (when women are called back for further tests) varied across programmes, they were only weakly linked to mortality.
Next steps
This study provides important evidence for improving breast screening quality across Europe. It shows that measures related to coverage, detection and sensitivity are the most useful indicators of impact.
Larger studies using individual-level data are needed to confirm these findings and to help set benchmark targets for these indicators.
The study highlights the value of international cooperation - combining high-quality data from different countries to strengthen evidence and share best practice.
Conclusion
By linking screening performance with breast cancer outcomes, this research helps European programmes focus on what truly saves lives.
For national breast screening programmes, it reinforces the importance of:
- reaching as many eligible women as possible
- maintaining high-quality testing and follow-up
- continually measuring and improving performance.
- Canelo-Aybar, Carlos, Autelitano, Mariangela et al., Evaluation of breast cancer screening programmes: Candidate performance indicators and their association with breast cancer mortality (2025), https://doi.org/10.1016/j.breast.2025.104621
- Murphy, Sophie et al., Evaluation of recall rates in the Irish national breast screening programme: Insights from two million screening mammograms, European Journal of Radiology, https://doi.org/10.1016/j.ejrad.2025.112179