Fifteen Years of Population-Based Breast Cancer Screening in the Netherlands

This article describes the background, implementation, organization, and outcomes of the nationwide mammography breast cancer screening program in the Netherlands. Since 1998, all Dutch women aged 50 to 75 years get a personal invitation for a mammography every 2 years. The main objective of the program that started in 1990 for women aged 50 to 69 is the reduction of breast cancer mortality by detecting and treating breast cancer in an early stage. Eighty percent of the invited women participate in the program. Some 1% of the screened women are referred for additional clinical assessment of suspect mammography lesions; in almost half of them, breast cancer eventually is confirmed. Breast cancer screening resulted in a temporary strong increase in in situ and small lymph node-negative invasive breast cancers and a concomitant decrease of advanced disease rates. In the same period, the proportion of mastectomies decreased in favor of a rise of breast conserving surgical treatment. Since 1997, breast cancer mortality has decreased significantly and has reached a 25% lower level 15 years after the start of the nationwide screening program. Undoubtedly, the screening program contributed to this decline, together with improved breast cancer treatment.