Background: Founded in 1988, The Screening Mammography Program of British Columbia (SMPBC) is a large, and stable screening program and a formal review of its effectiveness provides suggestions for further improvements. The purpose of this study is to quantify and report trends of the SMPBC and to assess if there have been any major changes in outcomes over the past fifteen years as this program has matured. Methods: A retrospective review of the SMPBC was performed by extracting data from the past 15 years from the SMPBC Annual Reports. The changes and trends in percentage of eligible population screened/participation rate, number of screening exams and number of first screens performed, overall cancer detection rate, and DCIS detection rate was extracted and reported. Furthermore, cost analysis data was extracted, and adjusted to compensate for inflation using The Bank of Canada Inflation Calculator, which bases its calculations from the Canadian Consumer Price Index (CPI) from Statistics Canada. Results: Over the past 15 years, the total number of exams provided per year has almost doubled from 166,746 in 1996 to 303,157 in 2010, and this increase accommodates the overall and aging growth of the BC population. An increasing participation rate is seen from 1999-2009 for women from rural sites and traditionally underserved areas of British Columbia, while the overall participation rate over this time period remains stable (range 48%-51%). The cancer detection rate also remains stable (range: 3.4-4.5 cases per 1000 screens). After adjusting for inflation, a 12.6% increase in the cost per screen from 1995-2009 is observed. This increase is multifactorial and includes an increase in operating costs central services and physician reading fees. Conclusions: The province of British Columbia has consistently had the lowest rates of breast cancer related mortality in Canada, and this may be, in part, because of the long term stability of the BC Screening Mammography Program. Our report suggests that the SMPBC has been effective in accommodating the growing aging population, although there is still room for improvement, as a target participation of 70% is considered the standard to effectively reduce mortality through screening.