EXECUTIVE SUMMARY

Breast cancer is the number one killer among women worldwide.(13) Early detection is believed to reduce breast cancer mortality. Systematic reviews show that mammography is an effective method of detecting cancer at an earlier stage and reduces the disease-specific mortality rates among the 50-69 age group.(14)five studies were eligible. Higher cancer detection rates were observed when comparing DBT + FFDM with FFDM in two European studies: the summary difference per 1000 screens was 2.43 (95% CI: 1.8 to 3.1 In Palestine, breast cancer is the most prevalent cancer in females and comprises 31.8% of all female cancer cases, with an incidence rate of 40.0 per 100, 000 female population. It accounts for approximately 22% of cancer deaths among women.

Although breast cancer is one of the cancers with the highest survival rate, success depends greatly on early detection. For those diagnosed with the disease, estimates of five-year survival rates can be as low as 40% and this makes breast cancer the highest cause of premature cancer deaths in Palestinian women. Survival rates could be improved if effective screening, early detection, and referral pathways were put in place.(15)

Extensive efforts have been exerted by the Ministry of Health (MoH) and its partners in detecting and treating breast cancer. It is a growing public health concern as more Palestinian women continue to be diagnosed and die from breast cancer.

Although the different pillars of breast cancer services, including control, prevention, early detection, and treatment, are available in Palestine, the connectivity, sustainability, and quality vary and require further improvement. Oncology services in the Palestinian context are briefly summarized in the Breast Cancer Services in Palestine section in this report, as well as full details on efforts made to improve mammography screening services, including the Mammography Registry.

Recognizing early detection of breast cancer as the cornerstone of breast cancer control and management, the MoH has focused efforts on enhancing early detection services. One of the key efforts is the establishment of the National Mammography Screening Program in 2008.

Following this assessment, the MoH and PNIPH made huge efforts to institutionalize a well-defined mammography registry and database that will enable monitoring of the operation and outcomes of MoH mammography facilities. Efforts to improve the mammography registry and its transition from a paper-based to an electronic registry, while tackling issues of completeness, data quality and the tracking of health outcomes, plus mammography program performance outcomes and indicators, have been enhanced by the establishment of the mammography electronic registry (Mammo e-Registry).

Developed with the support of PNIPH, the Mammo e-Registry is a patient tracking and data management software application available at no cost to health care providers and the MoH.

• Currently, the Mammo e-Registry is implemented by the MoH across all West Bank governorates throughout 14 primary healthcare facilities.
• It documents breast cancer screening services provided through mammography screening. It also supports HCPs to document detailed imaging results and interpretations using the BI-RAD classification system.
• The Mammo e-Registry includes standardized information on each encounter provided through the program. It also includes unique patient identifiers that can be used to track screening and diagnostic services to individual women over time. It records the demographic characteristics and clinical outcomes of women enrolled in the mammography screening program.
• The e-Registry provides timely and accurate data, and can produce routine statistics dashboards of selected indicators that support screening and breast cancer-related decisions, interventions, and guidelines through the built-in dashboard application.
• Rigorous processes are in place to ensure the completeness and quality of the Mammo e-Registry data collection.

Data from the Mammo e-Registry provide a rich source of information. Use of these data to improve performance is prioritized and allows the MoH to monitor program outcomes, support planning, improve performance, and refine MoH policies.

Purpose

This report presents the results of the 2016-2020 Mammo e-Registry data analysis and review of mammography services in the West Bank (WB) in MoH public healthcare clinics (PHCs). It covers the socio-demographic and risk factor profile for the beneficiaries of mammography service coverage and utilization, follow-up, and adherence to MoH screening policy.

Although the Mammo e-Registry has been in use among MoH PHCs for five years, this is the first report that presents indicators on case reporting, data quality, compliance in use of the e-Registry, etc. It provides conclusive recommendations for Mammo e-Registry quality improvements and breast cancer early detection.