Breast Cancer Screening

Article by Marina Geli Fàbrega, doctor and former Health Minister

Population screenings

Population-based screening is one of the most effective and equitable public health strategies for detecting diseases among population subgroups in the asymptomatic phase. Breast cancer screening reduces mortality by 30% in women over the age of 50. In Catalonia, public population-based screening is recommended for women aged 50 to 69, and between 5 and 10 breast cancers are detected per 1,000 mammograms. There are proposals to extend the screening age for breast and colon cancer screening from 45 to 75.

The healthcare system in Catalonia has established various screenings: prenatal and neonatal screening for 25 conditions, neonatal hearing screening, breast and colorectal cancer screenings, detection of cervical cancer and other screenings for infectious diseases or tumour markers. Colon cancer screening with faecal occult blood testing prevents cancer in many cases by detecting precancerous polyps. Human papillomavirus detection prevents cervical cancer.

In Catalonia, in 2024, 5,439 cases of breast cancer were diagnosed, representing 29% of all tumours in women, and nearly 80% of those were women over the age of 50. The distribution of breast cancers and mortality was as follows: 19 cases in under-29s, with no deaths; 1,137 cases in those aged 30–49, with 82 deaths; 2,625 cases in those aged 50–69, with 335 deaths; 1,658 cases in women over 69 years and 554 women died.

Five-year survival is 90% and 84% after ten years. 1,080 women died of breast cancer. The incidence of breast cancer is expected to stabilise with a slight downward trend, and its behaviour should be monitored in the coming years.

The early detection programme

The breast cancer early detection programme was significantly launched in 1996 and by 2003 had achieved 100% invitation coverage of the target population of women aged 50 to 69.

In 2023, 443,608 women aged 50 to 69 were invited to have a mammogram. 66% (292,881 women) took up the offer, resulting in the detection of 1,465 breast cancers.

The participation of women in the programme must be continuously reviewed. Adherence is higher in medium-sized towns and rural areas. For example, in Osona, public screening reaches over 80%.

Participation in the public breast cancer screening programme is higher among working-class and middle-class women, while women with higher incomes are more likely to use the private system. If the city of Barcelona is analysed, participation differences are observed between districts.

In 2023, 101,628 people were invited to participate, and 50.4% took part; if we include those who participated in other private programmes, the figure reaches 66.8%. The Barcelona districts of Sant Martí, Sant Andreu, Horta-Guinardó and Nou Barris have public participation rates of over 60–67%, whereas in districts such as Sarrià-Sant Gervasi the rate falls below 30%, with high participation in private healthcare.

Photo by National Cancer Institute on Unsplash

Equity by Income

Over the past thirty years in Catalonia, the number of women accessing mammograms for cancer detection by income level has remained virtually the same. The screening programme has been a determining factor. According to data from the ESCA (Health Survey of Catalonia), in 1994, 38% of women from high-income households had a mammogram periodically, compared with 20% of women from low-income households.

In 2017. 92% of women from high and middle-income backgrounds and 87% from low-income backgrounds. In 2023, 93% of women from high-income backgrounds, 92% from middle-income backgrounds and 91% from low-income backgrounds.

In colorectal cancer screening, the path towards income equity is similar. In 2012, 25% of people on high and middle incomes had a faecal occult blood test, and only 16% of people on low incomes; in 2023, the figures were 73% for high incomes, 67% for middle incomes and 60% for low incomes.

The European Union recommends extending the age range for breast cancer screening from 45 to 75 years, increasing participation to at least 90% and retention. Some Spanish autonomous communities have begun the change gradually: Galicia, the Basque Country, Castile and León, Valencia, Murcia and the Community of Madrid.

Other screenings such as hearing screening or osteoporosis screening in menopausal women.

The case of Catalonia and cancer

Catalonia launched its breast cancer screening programme almost 30 years ago, and the current results are robust and have contributed to equalising prognosis, narrowing the gap in outcomes due to social, cultural and economic determinants.

Catalonia must have the financial, technological and human resources for continuous improvement and to extend the age ranges for breast cancer screening. AI can help with image reading. We have other challenges: systematised screenings for lung, prostate and stomach cancer. Expanding colon cancer screening from 45 to 75 years of age.

Other screenings outside the cancer field, such as hearing screening for adults aged 55 and over, or Osteoporosis screening in menopausal women.  Yes, there is scientific evidence that population screenings are cost-effective, improve quality of life and extend healthy life expectancy.

Article by Marina Geli Fàbrega, doctor and former Health Minister

Find other articles by Dr Geli here.