October is widely recognized across Europe as Breast Cancer Awareness Month. In most European countries, cancer treatment is provided by expert centres, many of which are private. Cancer must be fought with all resources and private hospitals are also involved in prevention. Generally, the cancer care provision should be complemented and enriched by the private sector initiatives.
FRANCE
Does an organized breast cancer screening program exist in your country?
In France, the organised breast cancer screening programme is run by the National Health Insurance Fund (CNAM), as it is for colorectal and cervical cancer… with active supervisory bodies: the National Cancer Institute (INCA), the CNAM, the Ligue contre le cancer or the Haute autorité de santé (HAS).
Organised breast cancer screening in figures
– An estimated 10.8 million women aged 50 to 74 were eligible for the organised breast cancer screening programme in 2022-2023.
– The national participation rate for this screening programme is 46.5% for the period 2022-2023, compared with 47.76% for the period 2021-2022, a fall of 11.7%.
– After rising until 2010-2011, with a peak of 52.7%, participation in this programme has fallen over the last 10 years for all age groups and all regions. However, this does not include 11% of the target population who undergo individual screening (estimated by Santé publique France).
– There are also regional disparities: some regions have rates of over 60%, while others have rates of under 30%. As a reminder, the European target is 70%.
– Over the period 2019-2020, 38,773 cancers (invasive and in situ, excluding lobular carcinoma in situ) were registered, giving a rate of 7.8 cancers per 1,000 women screened as part of organised screening.
– The estimated number of deaths from breast cancer in France in 2021 is 12,600. Mortality from this cancer has fallen overall by 1.3% per year between 2011 and 2021. This is partly due to earlier diagnosis and advances in treatment.
Figures for the private hospital sector
Private clinics are responsible for 39.3% of carcinological surgery and 26% of chemotherapy sessions.
Is there a Pink October-type campaign in place in your country? Are private hospitals and clinics participating, and if so, how are they involved?
Private clinics are heavily involved in the campaigns Pink October for breast cancers and Blue March for colorectal cancers. See private hospital initiatives on FHP-MCO website: Octobre Rose and Mars Bleu
AUSTRIA
Breast cancer screening is an outpatient service in Austria and private clinics work in the inpatient sector. What private clinics do, however, is to provide the doctors working with them with appropriate practices and equipment so that they can provide these services as private or elective doctors. The only exception to this is an outpatient clinic in Vienna operated by a private clinic, which has corresponding contracts with the supplementary insurance for breast cancer screening. I hope this input helps.
GREECE
Free breast screening programme in Greece
The private healthcare sector participates in the National Programme for the Prevention of Breast Cancer, that provides free mammograms to women aged 45 to 74.
According to the European Commission’s European Cancer Information System, in Greece in 2022, there were detected 20,730 new cases of cancer in the 25-79 age group, with 35.4% referring to breast cancer 2.
The program covers 1.4 million women and offers free of charge, a digital mammography examination, an ultrasound and a visit to the doctor for women that have findings.
Referral notifications are generated automatically based on the Social Security Number, and the examinations are completely free for all insured and uninsured women.
Beneficiaries of the Action are:
- Women of Greek nationality and citizens of third countries legally in Greece
- Who belong to the age group of 45 to 74 years
- Have a Social Security Number
- Have not carried out the same tests in the last 12 months
- Have not suffered from breast cancer within the last 5 years
To better inform beneficiaries, the website mastografia.gov.gr has been created with all necessary information.
By September 2024, 410,000 mammograms were performed through the programme and 26,000 women were diagnosed in time.
The diagnostic tests and clinical examinations are carried out both in public and private healthcare facilities, while the expenses are covered by the Public Investment Program of the Ministry of Health and come from EU resources of the Recovery and Resilience Fund.
GERMANY
Extension of the programme for women aged 70 to 75
The mammography screening programme for the early detection of breast cancer is being extended: Until now, only women between the ages of 50 and 69 have been able to participate every two years. From 1 July 2024, women between the ages of 70 and 75 will be able to register for a screening appointment at a screening unit near their home. Entitlement will therefore end on the 76th birthday. Participation in the mammography screening programme is also associated with more benefits than risks for women aged 45 and over. This is the conclusion of the Federal Office for Radiation Protection.
The participation rate of women who were invited to the mammography screening programme for the first time was 46.5% in 2021.
A high participation rate of 85.3 % can be observed among women with a follow-up invitation after participation, while women with a follow-up invitation after non-participation have a participation rate of only 15.2 %.
With around 70,000 new cases every year, breast cancer is the most common cancer among women in Germany.
PORTUGAL
Extension of the programme for women aged 45
In October 2024, this month, the Ministry of Health reduced the age for the first screening from 50 to 45.
The Breast Cancer Screening Programme (developed in close collaboration with Primary Health Care) mainly uses Mobile Units that travel to each municipality every 2 years and Fixed Units. Notices are sent to women of screening age who are registered at the Health Centres to have a mammogram (free of charge).
This radiological examination is analysed by two radiologists who, if in doubt, will call the woman in for a clinical check-up. If there are any doubts, the woman is referred to a hospital where she will receive a final diagnosis and, if the suspicion is confirmed, treatment.
This is how more than 5.3 million screening mammograms have already been carried out nationwide (by the end of 2022) and more than 30,000 women have been referred for diagnosis and treatment, allowing for less aggressive, more effective treatment and, even in many cases, a total cure.
SPAIN
Private hospitals offer to collaborate with NHS to meet European mandate on cancer screening
Most of the Autonomous Communities have cancer screening programmes in place, although the speed of implementation is uneven, as is the population’s adherence to such screening.
The private hospital sector has 42% of the mammography machines in Spain, 52% of the MRIs and 32% of the CT scans, which can help in diagnosis. Currently, the private circuit already performs a significant number of preventive tests for breast, cervical and colon and rectal cancer, with the possibility of extending the execution of these tests, with the consequent relief for the public health system and the benefit it could bring to at-risk groups.
“The European Commission estimates that, if appropriate measures are not taken, cancer cases will increase by 24% by 2035, making it the leading cause of death in the EU. Screening programmes and early detection can change this picture. It is essential to join forces to achieve this,” says Carlos Rus, President of the Spanish Alliance of Private Hospitals (ASPE).
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