It could take three years to put all of the recommendations from the recent critical independent review of Breast-Screen Aotearoa into place.
That is the view of Dr Don Mackie, the chairman of the clinical steering group and the Ministry of Health's chief medical officer.
While the Australian reviewers praised the programme for its cancer detection and participation rates, they raised concerns about clinical governance and leadership of the programme, quality monitoring and efficiency.
The review was prompted by concerns raised a year ago by the clinical director of the Counties Manukau breastscreening programme, Dr Sally Urry, about the risks posed by a plethora of resignations of key senior staff from the National Screening Unit, which oversees BSA.
During the review, service providers were critical of the NSU's understanding of what was required for a quality programme, suggesting there was too much emphasis on compliance and contract management.
Dr Mackie said he was optimistic about the job ahead.
He emphasised the achievements of the breast-screening programme so far, saying it was aiming to reduce the deaths from breast cancer by 30% and had achieved a 24.5% reduction since 1990.
He agreed that attention could perhaps have been paid more quickly to some of the issues, but did not see the external review as a negative development.
Peer review was very much part of medicine and could be valuable to provide ‘‘a bit of a yardstick'', he said.
Asked whether this was a good time to be pushing for increased participation in the screening programme, Dr Mackie said the issues identified in the review were not of a scale to suggest the programme should take its ‘‘foot off the gas'' on participation.
Women should have every confidence about using the service, despite the review identifying areas which required improvement, he said.
One of the concerns raised was the lack of yearly-interval cancer studies. Such research looks at cancers found in the time between one routine mammogram and the next, and checked the last routine scan to see whether anything was missed at that point.
Reviewer Jennifer Muller described those studies as a key performance outcome for breast-screening programmes.
National Health Board national services purchasing director Jill Lane said the delay in the interval cancer study was related to timing and key personnel, not cost.
The last study was published by the National Screening Unit in 2007 and related to the 1999-2002 period. The following year the project to review interval cancers for 2002-03 began, but was delayed because of the resignation of the BSA clinical leader. That work was now being done and would cover the period January 1999 to December 2007, she said. It would be finished this year.
Reviews were expected annually after that.
The clinical steering group, which will also look at the other screening programmes to ensure there is a consistent approach to quality, had its inaugural meeting last year. It is expected to meet early next month to consider the 22 comprehensive recommendations from the reviewers and how to prioritise them.
Applications closed this week for a project director to support the implementation of the recommendations.