Background: Population-based mammography screening programs are effective strategies for reducing breast cancer mortality. However, their efficacy depends on continuous funding, quality assurance, case management models, and robust information systems for monitoring and impact assessment. Due to these requirements, the World Health Organization (WHO) does not recommend such programs for low and middle-income countries (LMICs), instead prioritizing the strengthening of early clinical diagnosis and comprehensive care for detected cases. Colombia has integrated mammography and clinical breast examination into its health benefits package, which has contributed to an upward trend in screening coverage, reaching 38.21% in 2024. Paradoxically, according to the administrative national cancer registry, the proportion of new cases diagnosed at early stages reached 54.03% in 2024. In 2019, the mortality rate was 11 per 100,000 women and in 2024 was 10.3 per 100,000 women.

The biggest challenge in Colombia is to reach the standards of an organized population-based program such as systematic active recruitment strategies, optimal mammographic image quality, case management, and early detection information systems. This presentation details a demonstration program aimed to strengthening breast cancer screening in Colombia to align with organized program criteria and with the Global Breast Cancer Initiative.
 
Objectives: To strengthen breast cancer screening actions in two Colombian cities with high breast cancer mortality rates through systematic interventions in healthcare provider coordination, capacity building for health professionals, quality assurance, public awareness, and monitoring and evaluation.
 
Methods: The program involves an intervention coordinated by the National Cancer Institute, the Ministry of Health and Social Protection, and local health authorities providing training, technical assistance for quality control, and design of an information system.

Results: A total of 360 primary care professionals were trained in clinical breast examination, 36 radiologists in mammography interpretation, breast ultrasound and breast biopsy, and 6 radiology technologists in mammography positioning techniques. Additionally, 1,671 professionals were trained through specialized webinars. Although screening coverage remained stagnant, the program facilitated the development of the National Guidelines for Early Detection of Breast Cancer launched jointly with the Ministry of Health and Social Protection in 2025, the development of national strategies for raising awareness of the disease and encouraging screening in mass media and the significant improvement of quality tracer indicators in mammography, such as the percentage of Bi-RADS 0 which went from 11,21% to 9,81,%, as well as the recall rate, which went from 16,31 to 15,40. The impact on the percentage of cases in early stages at the time of diagnosis was difficult to assess, due to reporting problems associated with the fragmentation of health care.

Conclusions/Implications: Breast cancer mammography screening in Colombia currently falls short of organized population-based program standards. Despite efforts by the National Cancer Institute and the Ministry of Health, the demonstration program did not fully meet its objectives, underscoring the challenges of implementing such programs, and the BGCI recommendations, in LMICs, even when continuous funding is available. Nevertheless, the favorable outcomes in professional training, quality assurance, and information management demonstrate the potential for improvement of existing interventions to benefit the population.