The Mammography Programme celebrates its 25th anniversary

The Cancer Registry of Norway and the Mammography Programme are now marking 25 years since organised mammography screening started in Norway.

The anniversary will be marked by a national professional conference on 13 and 14 June, and the publication of a report summarising 25 years of results.

The report shows that the results have been stable and within the requirements of Norwegian and European guidelines for mammography screening.

The head of the Mammography Programme, Solveig Hofvind at the Cancer Registry, is pleased with the solid results, but is nevertheless clear that now is the time for changes.

"The introduction of the Mammography Programme has helped to save more than 100 women annually from dying of breast cancer," says Hofvind. "It's really good, but we have to get better.

"For 25 years, we have also seen a stable proportion of women who are diagnosed with breast cancer between mammography examinations – how long should we accept that such figures remain unchanged, when we know that these are breast cancers that often have a poorer prognosis and that a more adapted service could reduce the proportion?" she asks.

Hofvind says this is just one example of areas where she would have liked to see opportunities to change and adapt the program, although she emphasizes that the current mammography program is a safe and solid service that she is proud to be the leader of.

A more customised screening programme?

Mammography is the best screening method we have today, but is not 100% safe. The time is ripe to take the Mammography Programme a step further, test and find better solutions," says Hofvind.  

"Knowledge about breast cancer and mammography screening is far greater today than it was a quarter of a century ago, when the Mammography Programme started," she says, and believes this should be taken into account.

Among other things, we know that so-called mammographically dense breasts – which means having a lot of dense glandular tissue in the breast – is not only a risk factor in itself for developing breast cancer, but also increases the risk that breast cancer tumours will not be detected on mammography. This is because mammography images show dense glandular tissue with the same grey hue as cancerous tumours, and thus can make it difficult to detect the tumour if it is hidden in the dense glandular tissue.

"Now in 2022, we know that mammograms are not the best thing for women with extremely dense breasts. Fortunately, this applies to only about 3 percent of the almost 650,000 women in the target group, but for these women we would have liked to be able to offer a more effective examination method than mammography," says Hofvind.

She says that earlier this year there were new recommendations from a European expert group that women with extremely dense breasts should be offered MRI as a screening examination instead of mammography, and believes this is also relevant to consider in Norway. She says ultrasound may also be well suited as an adjunct to mammography for women with extremely dense glandular tissue.

Artificial intelligence is the future

Hofvind is also convinced that artificial intelligence is a key factor for a more modern, precise and cost-effective screening programme in Norway. She says several studies both internationally and from the Mammography Programme are ongoing and show promising results, both for society and women, for the use of artificial intelligence in the assessment of mammography images.

"Our studies indicate that artificial intelligence can contribute to the assessment of mammography images in such a way and to such an extent that we could save considerable medical resources in the Mammography Programme, without compromising quality and women's safety," says Hofvind.

Read here about the Mammography Programme's projects in artificial intelligence.

She emphasizes that more studies and more knowledge are needed before artificial intelligence can be introduced, but is nevertheless optimistic about what can be achieved.

"The latest cancer figures show that breast cancer is still a serious disease that affects many women in Norway. We must continue to work to increase the benefits and reduce disadvantages for the women in the Mammography Programme, and we can do this by adapting and streamlining the programme, based on the knowledge we have accumulated over all these years," says Hofvind.

Hofvind is clear that the current access to resources for the Mammography Programme is not sufficient to implement all the changes that are needed, and also says that the Cancer Registry does not have the authority to make the decisions and priorities necessary to implement relevant changes.

"We need a joint effort with the health authorities and the health authorities to be able to implement this type of restructuring in the Mammography Programme, so now we hope this 25th anniversary gives us a good opportunity to talk about all that has been achieved and what we need next, so that we all see the needs. she concludes.

Breast cancer 

Thanks to early detection and better treatment, most women today survive their breast cancer diagnosis.

Several are also treated more gently because the disease is most often detected at an early stage of development. This results in fewer side and late effects, which in turn has a positive effect on later quality of life in the women affected.

Read more about breast cancer and its developement over time here.

Figure: Trends in incidence (red), mortality (pink) and 5-year relative survival (brown) of breast cancer among women in the period 1965-2020. From Cancer in Norway 2021, fig. 9.1-M.