Breast Cancer Screening

Number of women in the target population – unique women within the age range defined under the nationally organized breast cancer screening programme (50–69 years), in accordance with Cabinet of Ministers Regulation No. 555 of 28 August 2018, “Procedures for the Organization and Financing of Health Care Services”.
The target population is calculated based on the average number of women in Latvia in the relevant year and divided by the screening interval – 2 years.

Unique women invited - unique women for whom an invitation letter to participate in the breast cancer screening programme has been prepared and sent, according to information recorded in the National Health Service (NHS/NVD) information system.

Invitation coverage - the ratio of the number of unique invited women to the annual target population. It indicates the proportion of the target population that received invitations during the defined screening period and provides information on the effectiveness of programme organization (target: 95% – acceptable level; >95% – desirable level).

Unique number of women who underwent screening examinations - unique women who received the primary screening examination (mammography) within the nationally organized breast cancer screening programme, in accordance with regulatory enactments Cabinet of Ministers Regulation No. 555 of 28 August 2018, “Procedures for the Organization and Financing of Health Care Services”, and whose examination is coded in the NVD VIS according to the requirements set by the National Health Service for the provision of the national breast cancer screening programme (see – Data Selection Criteria)

Examination coverage - the proportion of screened women within the target population.

This indicator is calculated as the ratio of women who underwent screening examinations to the target population. It indicates what proportion of the target population received a screening mammography during the defined period and provides information on the organizational effectiveness of the screening programme (target: 70% – acceptable level; >85% – desirable level).

Participation (response rate) – the proportion of invited women who actually underwent screening.

This indicator is calculated as the ratio of women who underwent screening examinations to the number of women invited in a given year. It indicates the organizational effectiveness of the breast cancer screening programme (target: 70% – acceptable level; >85% – desirable level).

Distribution of primary screening results - the number of unique women according to the result of the primary screening examination. The distribution follows the classification of examination results defined in Cabinet of Ministers Regulation No. 555 of 28 August 2018, “Procedures for the Organization and Financing of Health Care Services.” Results are obtained from the NVD VIS screening module results section.

Examination methods and result coding by period

2009-2022 – R classification

• R1 – normal
• R2 – potentially benign finding / isolated benign lesion
• R3 – suspicion of pathology / localized pathological changes
• R4 – potential malignancy / suspicious malignant lesion
• R5 – confirmed malignancy / malignant finding

From 2022 – BI-RADS classification

During the transition period, R classification results are also recorded and listed under "Unknown".

• B0 – additional examinations required
• B1 – negative finding
• B2 – benign finding
• B4 – suspicious for malignancy
• B5 – highly suggestive of malignancy

Age groups – unique women are grouped into five-year age bands from 25 to 69.

The methodology was developed and adapted by the Centre for Disease Prevention and Control (SPKC), Research and Health Statistics Department, in cooperation with the National Health Service (NVD), based on indicators compiled by the European Commission and described in the scientific article Muratov S, Canelo-Aybar C, Tarride JE, et al. Monitoring and evaluation of breast cancer screening programmes: selecting candidate performance indicators. BMC Cancer. 2020;20(1):795. Published 2020 Aug 24. doi:10.1186/s12885-020-07289-z.

The methodology takes into account the capabilities of Latvian data systems and international guidelines, providing a systematic and methodologically sound approach for describing breast cancer screening indicators and programme monitoring. By introducing a screening registry, as well as ensuring additional data availability and quality control, the methodology will be supplemented and adapted to the current situation.

• Healthcare Payment Billing System “Management Information System” (MIS) of the National Health Service (NHS) – information on invitation letters sent, screening examinations performed, and their results
• Central Statistical Bureau (CSB) – data on the target population

Women who have undergone screening examinations are selected from the National Health Service Management Information System (NVD VIS) in accordance with the Conditions for the Provision of the Nationally Organized Breast Cancer Screening Programme published by the NVD.

Primary diagnosis code: Z12.3 – breast cancer screening examination (ICD-10).

To calculate the number of unique screened women, women who underwent mammography during the calendar year are selected according to NVD outpatient procedure codes:

R classification (until 2022):

• Mammography (50096)
• First radiologist report R1–R5 (50188–50192)
• Second radiologist report R1–R5 (50246–50250)

BI-RADS classification (from 2022):

Each woman is counted once, regardless of the number of procedures performed. To calculate the number of unique women with a specific Bx(N), the final results entered in the Breast Cancer Screening module results section (R1–R5 / B0–B5) are analysed.

Anita Mauriņa

Head of the Registry Supervision Unit

Phone: +371 67387665

Renāte Putniņa

Public Health Analyst

Phone: +371 27893727

Annika Smilga-Veide

Public Health Analyst

Phone: +371 67475147