Οργανωσιακή δομή εθνικού προγράμματος οργανωμένου προσυμπτωματικού ελέγχου για τον καρκίνο του μαστού στην Ελλάδα.
Organizational structure of a national breast cancer screening programme in Greece.
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Μαστός -- Καρκίνος ; Καρκίνος -- Πρόληψη ; Medical screening -- Greece ; Breast -- Cancer -- GreeceAbstract
Breast cancer is the most frequently diagnosed type of human malignancy and the leading cause of death in females, worldwide. Even though its incidence rate in Greece is one of the lowest among the European countries, significant increases are expected in the following years. As a result, breast cancer emerges as a major public health issue. Screening or secondary prevention is an effective measure for the early detection and diagnosis of breast cancer. It offers great benefit to individuals as well as to society, since it efficiently reduces mortality and morbidity rates due to the disease. Maximization of the associated benefits is achieved through the implementation of organized screening programmes, in the context of specific health-related policies. Most European countries have already established and run organized breast cancer screening programmes, according to the European recommendations. On the contrary, breast cancer screening in Greece is mostly opportunistic. The present study aims to elucidate the organizational structure of an organized breast cancer screening programme in Greece, taking into account the local epidemiology of the disease, the characteristics of the Greek health service and the availability of its resources in hospitals, equipment and manpower. For this purpose, an extensive review of the current literature on the European breast cancer screening programmes was originally performed, emphasizing on three specific European countries. Subsequently, and taking into consideration that the opinion of the Greek experts is of major importance, a qualitative research was applied using the methodology of in depth interviews with experts. The interviews aimed to define the basic characteristics of a breast cancer screening programme in Greece, its requirements in terms of breast units and their operational specifications. The integration of the screening programme within the Greek health service, the way it is organized and the authorities for its management and control were also defined. Finally, the feasibility of the implementation and the cost effectiveness of an organized breast cancer screening programme are discussed. According to our research data, breast cancer screening is applied in all healthy Greek women aged between 40 and 74 years. It involves mammography and clinical breast examination, carried out by experienced health professionals, and is repeated biennially. Screening services are delivered in organized Diagnostic Breast Imaging Units. Breast Assessment Units and Specialist Breast Units manage women with suspicious findings or breast cancer, respectively. All breast Units are located within public hospitals and follow their hierarchy. The private health sector is involved in breast cancer screening, in cases where the public health service is unable to efficiently cover womens’ needs. Breast cancer screening is organized in a centralized structure, according to which the local control and coordination of the activities of each Unit is administered by the Oncology Committee of the corresponding hospital, where it is located. Regional management of screening is allocated to the District Health Directorates of the country, through special committees. The overall management, coordination and control of breast cancer screening is centralized in a national commission, that is responsible for all related functions. An independent body is responsible for the quality assurance of the programme. The elucidation of the organizational structure and the process flowchart of a national organized breast cancer screening programme in Greece derives from the combination of all of our findings. According to the experts, such an initiative is both feasible and cost effective, even during recent financial crisis.