Background. Breast cancer (BC) is the leading malignancy in the cancer structure in Kazakhstan and is associated with a high socio-economic burden. Since 2008, Kazakhstan has implemented a population-based screening program using standard two-view mammography. Over this period, various approaches aimed at improving screening effectiveness have been introduced.
Objectives. To develop and implement approaches to improve the effectiveness of BC screening.
Methods. A prospective, population-wide study including all patients who underwent screening examinations was conducted. Screening indicators (coverage, cancer detection rate among those screened, proportion of early-stage cancer, access to mammography) were assessed in comparison with epidemiological indicators (incidence, mortality per 100,000 women, stage distribution). Changes in these proportions between consecutive years were evaluated by calculating the annual percentage change. Since 2011, detected cancer cases have been cross-checked with data from the National Cancer Registry (ECR).
Results. Double reading of mammograms using the BI-RADS system was introduced in 2011, and breast density assessment using the ABCD system in 2020. The target age group was expanded from 50–60 years to 40–70 years in 2018, and up to 76 years in 2024. Since 2012, a screening quality monitoring system (assessment of image quality, positioning, and analysis of missed cases) has been introduced.
At the start of the screening program, 116 analog mammography units were in use nationwide. From 2013, equipment modernization and digitization were carried out. By the end of 2025, the country has 400 mammography units, with a digitization rate of 97%.
Between 2008 and 2025, 10,930,426 women were screened, and 19,017 cancer cases were detected; according to the ECR, 14,260 breast cancer cases were identified during 2011–2025.
Conclusions / Implications for Practice or Policy. The implementation of international quality standards since 2012 and the phased digitization of equipment since 2013 made it possible to increase the annual number of detected BC cases from 261 cases per year in 2010 to 886 in 2017 and 1,836 in 2025. The cancer detection rate increased from 0.09–0.10% in the early years of screening to 0.20% in recent years (0.23% in 2016). The rate of early cancer detection increased from 21.1% to 57.1%, representing a 170% increase. Incidence rose from 40.1 to 55.1 (an increase of 37.4%). Mortality decreased by 42.3%, from 17.5 in 2008 to 10.1 in 2024. In the general population, the proportion of early-stage BC increased from 23.1% in 2017 to 37.4% in 2024, i.e., by 61.9%. An increase in overall 5-year survival was also observed.
Despite significant positive outcomes, challenges remain, including insufficient coverage of the eligible population (66% of the insured population by age) and the BC detection among women who have undergone screening. The regulatory framework and financing of screening programs are being improved.
Technical quality control has been strengthened. Training programs for radiologic technologists and radiologists are being updated. The potential use of AI in mammography is being evaluated. Modernization of mammography equipment continues. Further screening quality assurance is required, including enhancement of medical information systems and increased population engagement.