BreastScreen Norway is based on the Norwegian Directorate of Health's criteria for screening (1), the radiation protection regulations (2), the cancer registry regulations (3), as well as European and other international recommendations and guidelines for screening, diagnostics and treatment of breast cancer (4,5). The Cancer Registry of Norway administers the program, and several institutions are involved in running the program(6).
The Ministry of Health and Care Services has overall responsibility for BreastScreen Norway, and makes political decisions about major changes in the program.
The Norwegian Directorate of Health is a professional authority with a normative role towards the health service and an advisory role towards the Ministry of health and care services. The Directorate represents the authorities and has a role in following the activites of BreastScreen Norway. They appoint members to and are the secretariat for the steering group for the cancer screening programs (see below).
The Cancer Registry of Norway is responsible for planning and sending invitations to screening, as well as for the results letters to women whith no signs of breast cancer. Other tasks are related to information dissemination, development and operation of IT systems and infrastructure, coordination of technical quality assurance, as well as coding and registration of screening information. The Cancer Registry is also responsible for monitoring, quality assurance, quality control and improvement of the screening program, research within the fields of mammographic screening and breast cancer, as well as cooperation with national and international professional networks. The Cancer Registry thus has both a coordinating and operational role in BreastScreen Norway.
The Regional Health Authorities have two statutory tasks associated with BreastScreen Norway; they own the health trusts in their health region and they are responsible for offering specialist health services in their region. The regional health authorities are responsible for BreastScreen Norway being offered as a public health service in their region. This is responsibilty is executed through the providing of breast centers at the health trusts. All the regional health authorities are represented in the steering group for the cancer screening programs (see below). The regional health authorities are also responsible for technical and physical quality assurance of the equipment used for taking and interpreting mammograms in the program.
In line with requirements in the radiation protection regulations, the health authorities and the Cancer Registry have jointly drawn up a "Programme for Technical Quality Assurance" (PDF, in Norwegian).
The local health trusts are responsible for carrying out the screening activities within their geographical area. This includes facilitating and carrying out screening examinations and any additional examinations, as well as ensuring further follow-up with investigation, diagnostics and treatment of the screening participants. The health trusts are responsible for premises, equipment and personnel related to screening and follow-up activities and must ensure that health personnel are, and remain, qualified and competent to deliver the services. The health trusts have financial responsibility for their activities.
An overview of the health trusts in BreastScreen Norway with breast centers and screening units can be found here (in Norwegian).
A steering group for the national cancer screening programs was established by the Nowegian Directorate of Health in autumn 2022. The steering group is led by the Directorate of Health, which also serves as the secretariat for the group. The group consists of one representative from the management of each regional health authority, the director of the Cancer Registry of Norway, one representative from the Norwegian Association for General Practitioners, one representative from the Norwegian Association of Local and Regional Authorities and one representative from the Norwegian Cancer Society. The group's mandate is to discuss, advice on and decide matters related to the national cancer screening programs. The group monitor the status and development of the programs, and ensure that they are run in line with guidelines and the national framework for screening programs in Norway.
An advisory group for BreastScreen Norway was established by the Norwegian Directorate of Health in 2022. The group is a professional forum where different views and perspectives related to the BreastScreen Norway are to be widely discussed. The group should give advice to the steering group and to the instiutions who operate in BreastScreen Norway and carry out the screening activities. Mandate and composition are decided by the Directorate of Health. The advisory group is made up of professionals and user representatives from relevant institutions, professional areas and associations. The Cancer Registry of Norway is the group's secretariat.
Groups of professionals within radiography, radiology, pathology and medical physics have been established by the Cancer Registry of Norway. These groups have a common mandate and should give advice and guidance to the Cancer Registry on issues within their professional area. The groups should also anchor and ensure communication within their own professional networks. The members should focus on quality assurance and improvement of the program and contribute with their competence in research projects that use data from BreastScreen Norway. Members of the groups are, in collaboration with the Cancer Registry, responsible for updating and revising the quality assurance manual, and should contribute to the establishment of national and international networks. The groups consist of representatives from the various professional disciplines, from all health regions.
From pilot project to nationwide publice health service
The public health service of mammographic screening in Norway started in 1995/96 as a pilot project in four counties: Rogaland, Oslo, Hordaland and Akershus. The pilot project had a time frame of four years when it started, and was intended to invite women 50-69 years of age for screening mammography twice during the project period.
The main objectives of the pilot project were twofold: to identify working methods that could reduce breast cancer mortality among the invited women, and to test the organisational, financial and professional aspects of a screening program. A more detailed description of the pilot project and its results are published in a report from the Cancer Registry of Norway (7).
Based on positive results gained from the first screening round, the Norwegian Parliament decided in 1998 that the project should be expanded to a nationwide program. This resulted in a gradual start-up county by county until it became nationwide. The last county started mammographic screening in February 2004, and by the end of 2005 all women aged 50-69 had been offered the public service of mammographic screening.
1. Helsedirektoratet. Screeningkriterier: Helsedirektoratet; 2022 [updated June 30, 2023; retrieved September 19, 2023]. Accessible from: www.helsedirektoratet.no/tema/kreft/screeningprogram-for-kreftf#screeningkriterier.
2. Helse- og omsorgsdepartementet. Strålevernforskriften: Lovdata; 2016 [retrieved September 19, 2023]. Accessible from: https://lovdata.no/dokument/SF/forskrift/2016-12-16-1659.
3. Helse- og omsorgsdepartementet. Kreftregisterforskriften: Lovdata; 2001 [retrieved September 19, 2023]. Accessible from: https://lovdata.no/dokument/SF/forskrift/2001-12-21-1477?q=kreftregisterforskriften.
4. European Commission. European guidelines on breast cancer screening and diagnosis: European Commission; 2023 [retrieved September 19, 2023]. Accessible from: https://healthcare-quality.jrc.ec.europa.eu/ecibc/european-breast-cancer-guidelines.
5. European Commission. Development of the European guidelines: European Commission; 2023 [updated March 22, 2023; retrieved September 20, 2023]. Accessible from: https://healthcare-quality.jrc.ec.europa.eu/ecibc/methodologies/european-guidelines.
6. Kreftregisteret, mammografiseksjonen: Ertzaas AK, Holen ÅS, Mangerud G, Pedersen K, Sagstad S, Hofvind S. Kvalitetsmanual i Mammografiprogrammet. Ansvarsforhold, retningslinjer og kvalitetsindikatorer. Oslo: Kreftregisteret, november 2023. Accessible from: www.kreftregisteret.no/Generelt/Rapporter/Mammografiprogrammet/Kvalitet/
7. Kreftregisteret. Forskningsrapport nr. 2-2000: Mammografiprogrammet i Norge. Evaluering av prøveprosjektet 1996-2000. Oslo: Kreftregisteret. Accessible from: www.kreftregisteret.no/globalassets/mammografiprogrammet/rapport_proveprosjektet_2000_korrigert_tabel_3.pdf