[The Breast Program--25-year role of the health service]. / Mamaprogrammet--25 år Hälsovårdens roll.

In screening for breast cancer, the discovery of screening positive cases can be carried out either with screening mammographic examination, with breast physical examination, or with breast self-examination. The screening positive cases should be examined with diagnostic mammographic examination. In BSE-screening, one-way communication about BSE does not influence health behaviour like e.g. monthly BSE-performance, followed by self-referral to a physician if breasts change from normal. Aimed at behavioural change, two-way communication strategies are needed in comprehensive program designs. The finnish Mama Program Screening is based on delivery of the message with two-way communication and the use of specially designed Mama-calenders for follow-up of the health behaviour of the participants during the continuous program. In a cohort, exposed to the Mama Program, compliance with BSE increased from 2% to 55% monthly performance. Two percent self-referred to the diagnostic mammographic examinations arranged within public health care facilities. In a 14 years follow-up of the complying women, 20% more breast cancers were detected than expected and mortality from breast cancer was 29% less than expected in all age groups. The Mama Program Screening has been implemented in public health care in Finland on a voluntary basis as an easy and inexpensive basic screening for women in all ages. It can be implemented in different PHC and private health care systems.

Incidence and mortality from breast cancer in the Mama Program for Breast Screening in Finland, 1973-1986.

BACKGROUND: A cohort of women enrolled in the Mama breast self-examination-(BSE) containing breast screening program in Finland from 1973 through 1975 (with BSE used for screening and mammography for diagnosis) was studied. METHODS: Twenty-eight thousand seven hundred eighty-five women who returned calendars recording their practice of BSE over a 2-year period have been followed by linkage with the records of the Finnish Cancer Registry through 1986. The incidence of and mortality from breast cancer was compared with that expected in the Finnish population based on a model incorporating Finnish national data for breast cancer incidence and case fatality. RESULTS: Breast cancer incidence was higher than expected (a rate ratio of 1.19 over all ages). The stage distribution of cases was not different from that expected from Finnish cancer registry data for 1980, but the breast cancer mortality was lower than expected (a rate ratio of 0.75). The latter difference occurred mainly in Years 3-6 of the follow-up period. The effect seemed similar in women under and over the age of 50 years. The cohort was of higher educational status than the Finnish population, and the mortality from all causes was lower than the general Finnish population, an effect seen in previous studies of compliers with breast screening. CONCLUSIONS: The reduction in mortality from breast cancer in the study cohort is consistent with an effect of the BSE-containing Mama program, though selection bias, inherent in any observational study of screening, provided an alternative explanation for the findings.

Preliminary results of primary screening for breast cancer with the Mama Program.

In 1972 a comprehensive BSE screening strategy for the early detection of breast cancer, the "Mama Program Screening" (MPS), was developed in Finland by the author on the initiative of women's organizations. The program consists of a) initial information about the facilities of the program and BSE-performance, b) prospective surveillance of the BSE-behaviour of complying women, who use a specially designed Mama calendar for regular notes on their BSE behaviour and c) a pre-organized system for women with self-identified anomalies in the breasts to self-refer to physicians in public health care. From 1973 to 1975 an MPS project was carried out in Finland with 56,000 exposed women. Compliance to BSE-performance of once a month increased from 2% prior to the enrollment to 55%, and resulted in 2% of self-referrers. In the compliers, mortality from breast cancer was reduced overall by 29%, the screening being effective in all age groups, also in those under 50 years. The MPS was easy and inexpensive to implement in existing public health care systems with the information material developed for the study and with physicians in PHC facilities.