Inspectorate concerned about quality of breast cancer screening

The Healthcare and Youth Inspectorate is concerned about the quality of the national breast cancer screening. Women who participate are generally satisfied, the Inspectorate found. But screening employees are under pressure from too high a workload, and that could cause problems. The screening also doesn’t sufficiently reach women of color and women from low-income households, the Inspectorate said on Tuesday.

The Inspectorate spoke with the employees in the national organization that carries out the population screening for breast cancer, visited 10 screening centers, observed 65 examinations, and spoke to 37 participants. Women, transgender men, and non-binary people with breasts between the ages of 50 and 75 are invited for screening every two years. Over a million invites go out every year.

The Inspectorate found that the quality of the screening is currently sufficient. Most women and other participants are satisfied and leave feeling well-informed and taken care of. “But employees are under pressure, which can reduce quality,” the Inspectorate said.

The screening staff face a high workload. Strict requirements for the screening images place them under enormous pressure to perform. Getting the images just right also leaves them with less and less time to speak to the patients involved, providing explanations and putting them at their ease.

The work culture is such that employees don’t feel comfortable learning from each other and reflecting on what can be improved, the Inspectorate said. There is no national, uniform system for recording and learning from incidents. Screening employees also refer women with abnormalities to a hospital for further testing, but most hospitals don’t give feedback. As a result, the screening employees don’t know whether they correctly referred a woman or whether it was a false alarm, and they can’t learn from it.

“The organization's board has insufficient insight into risks and does not focus enough on improvements,” the Inspectorate said. It also needs to do more to reach women of color and women from low-income households who are currently underrepresented in the screenings.

The Inspectorate gave the Netherlands Population Screening organization three months to submit an improvement plan.