National Public Health and Medical Officer Service (ÁNTSZ) Report on Hungary. Kitti Horváth, MD on behalf of Lajos Döbrőssy, MD

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1 National Public Health and Medical Officer Service (ÁNTSZ) Breast cancer care and implemented quality assurance Report on Hungary Kitti Horváth, MD on behalf of Lajos Döbrőssy, MD Chief Medical Officer s Office, Hungary Plenary of the European Commission Initiative on Breast Cancer Lago Maggiore District, Italy, 9-11 December 2015

2 Hungary middle-income Central-Eastern country joined the European Union in million inhabitants decreasing population, ageing society

3 Birth rate 9.1 births/1,000 Death rate 13.0 deaths/1,000 Growth rate -3.3 Fertility rate 1.34 children born/woman Life expectancy 74.8 years -male 71.0 years -female 78.8 years mortality of men <65 years mortality of women <65 years developed EU states simultaneously joined EU states 2.5 x 1.2 x 1.7 x 1.2 x 3

4 Health care health expenditure: 7.7 % of GDP hospital bed density: 7.2 beds /1.000 physician density 3.41 physicians /1.000 number of nurses and midwives: (incl. professional and auxiliary personnel) significant migration of workforce to other EU states 4

5 Cancer burden of Hungary (2014) 2nd most common cause of death after cardiovascular diseases overall cancer incidence is the highest in the EU28 and it is slightly increasing, particularly in females overall cancer mortality rate: male / female /

6 Breast cancer (2013) 3rd most common cause of cancer death among women new cases: 34.7 / fatal cases: 25.0 /

7 Breast cancer screening and care Organized mass screening for breast cancer is a public health action, performed within the framework of the healthcare system. 1. Chief Medical Officer s Office (OTH) on behalf of the National Public Health and Medical Officer Service (ÁNTSZ) operating license organization, management, coordination, monitoring and evaluation National Screening Coordination Department National Screening Registry 7

8 Breast cancer screening and care 2. Health Insurance Fund (OEP) notification list for personal invitations (issued by the National Screening Registry) follow-up, financing 3. National Institute of Oncology (OOI) professional responsibility National Cancer Register Itself the patient care is organized at a regional-local level. Women from 45 to 65 years are invited biannually for screening (clinical examination + two view mammography). 8

9 women with NO symptoms women WITH symptoms rehabilitation hospice MAMMOGRAPHY negative result non-negative result P r o c e s s radiotherapy treatment surgery chemotherapy recall in two years verification process DX, US, FNAC, CB diagnosis (incl. pathology) 9

10 Location facilities are available since breast screening centers further satellite and mobile units 10

11 Breast cancer screening (2013) uptake of organized breast screening services : % recall rate: 5.46 % biopsy offered to 9 % of those with non-negative screening result specimens: 87 % positive, 13 % negative <10mm 34.5 %, >20mm 17.2 % rise in the number of in situ and early stage breast cancer diagnosed among the screen-detected new cases obstacles: opportunistic examinations 11

12 Quality assurance -screening Mammography Units compliance rate recall rate cancer detection rate National Screening Registry National Institute of Oncology (OOI) incidence of interval cancer diagnostic confirmation results of FNAC 12

13 Quality assurance -care 1. Ministry of Human Resources, Secretariat of Health protocols for cancer care (18/2013.III.5.) 2. National Insitute of Oncology (OOI) international quality management certificate (ISO 9001:2008) guidebook on complex diagnostics and therapy of cancer They are supposed to provide professional standards by which quality of breast cancer screening and care would be assured. However these tools are voluntary. 13

14 Future plans 1. evaluation of current breast screening centers 2. reconsideration of regions 3. optimization of finances 4. involvement of private sector 5. training of radiographers 6. awareness campaign 14

15 Thank You very much for your attention! De morbo veteri nescit medicina mederi. - latin proverb 15

16 Lajos Döbrőssy, MD 16

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