Contribution of the Belgian Cancer Registry to Cancer Screening Programs:

Plan-Do-Check-Act

Julie Francart

Isabel De Brabander

Cancer screening programs in Belgium

50-69 yrs

50-69 yrs

50-69 yrs 50-74 yrs

50-74 yrs

25-64 yrs

50-74 yrs

Databases and linkages

IMA/AIM data Breast

IMA/AIM data Colon

IMA/AIM data Cervix

Laboratories for pathological Anatomy

Health insurance compagnies

Belgian Cancer Registry

ScreeningPrograms Cancer

registry

IMA/AIM data Cancer

Oncological care programs

Unique identifier:SSN

Cervix Breast Colon

Cyto-Histo pathology registry (CHP)

Contribution of the Belgian Cancer Registry

Plan – Do – Check - Act

Available Data on:• Diagnostic/screening procedures• Description of lesion

(no, benign, malign)

• Follow-up/Treatment

Research projects

Evaluation/Quality assurance

Cost-effectiveness

Policymaking

Exclusion lists: reducing costs and overscreening

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Months before participation to screening

Overscreening in the Flemish breast cancer screening program

2015

2016

2017

▪ Check: % of overscreened participants

to organized screening, Flemish Region

▪ Plan/Do: Implementation

of exclusion lists

In 2015, more then 11.000

women were overscreened

Exclusion lists: reducing costs and overscreening

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Months before participation to screening

Overscreening in the Flemish breast cancer screening program

2015

2016

2017

▪ Check 2017: almost 4800 less women

were overscreened compared to 2015

▪ Act: Implementation of exclusion lists

at the end of 2016, Flemish Region

Exclusion lists: reducing costs and overscreening

▪ Check 2017: 15% of the target

population, n=180.178, could be

excluded

▪ Reducing cost invitation letters

and FIT tests

▪ Act: Exclusion lists, Walloon Region

13,0%

1,7%

84,9%

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10,0%

20,0%

30,0%

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100,0%

Target population-July 2017

Exclusions, colorectal cancer screening, Walloon Region 2017

To be invited

Exclusion because ofFaecal occult blood test

Exclusion because ofColonoscopy

Exclusion because ofColorectal cancer/colectomy

0,5%

From screening results toFollow-up data and Fail-safe

IMA-data Cervix

Belgian Cancer Registry

Cervix CHP

Cancer registry

All cervical samples diagnoses: Pap smears, HPV tests, Biopsies,…

All cervical cancer diagnoses

All cervical diagnostic or therapeutic procedures

Laboratories for pathological Anatomy

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From screening results toFollow-up data and Fail-safe

▪ Check: Evaluate % of abnormal cytology without follow-up, Flemish Region

Total number of cytologies •210.038

Abnormal cytologies

•16.173 (8%)

Without follow-up within 12

months

•3.235 (20%)

Flemish Region, eligible population 2016, reimbursed cytologies

93%84%

7%16%

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100%

HSIL (n=1246) ASC-H (n=946)

% of High grade or ASC-H lesions without follow-up within 12 months

Known follow-up Unknown follow-up

n=82 n=150

▪ Plan: Fail-safe

▪ Do: Implementation of Fail-safe

mechanism, Flemish Region

Clinicians

▪ Act: First Fail-safe list to CvKO (Oct 2018)

1st phase: 287 ♀ with

HSIL or ASC-H

▪ Check impact by BCR

From screening results toFollow-up data and Fail-safe

Cancer detection and characteristics▪ Check: Number and stage of screen detected

cancers, interval cancers and cancers in non-participants, Flemish Region

50,9%

24,2% 27,2%

26,1%

17,7%19,3%

8,3%

20,4%17,0%

11,8%

20,3% 20,7%

2,9%

17,4% 15,7%

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100,0%

Screen detected cancers(n=2.042)

Cancers in nonparticipants (n=1.447)

Interval cancers(n=305)

Stage in screen detected cancers, interval cancers and cancers in non participants, Flemish eligible

population, incidence year 2015

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▪ Plan/Do/Act:More detailed investigation of interval cancers:

Gender-Age- numerical FIT result-Screening round- Tumor localization- History of adenoma/colonoscopies

Collaboration with:

Take home messages

▪ Close collaboration between the BCR and the cancer screening programs leads to:

• A cost-effective organization of the screening programs

• Quality assurance and improvement of the screening programs

▪ Data handling, -linkage and -exchange is indispensable for the quality assurance of screening programs and should be in line with privacy regulations