The control of breast cancer through mammography screening. What is the evidence?

There are few forms of cancer that can be effectively controlled. Now that there is sufficient evidence demonstrating that mortality from breast cancer can be reduced with the help of mammography screening, we are faced with the challenge of applying this method on a large scale. What are the major practical problems? The medical profession and decision makers must be made familiar with nature of the recent achievements and with their practical implications. The personnel who will be responsible for undertaking screening have to be adequately trained before screening gets under way. Women should understand the benefits that they can gain from mammography screening so that they will be sufficiently motivated to attend. This can be achieved by sincere, periodic information through the mass media. It is important that every woman eligible for screening understand that her risk of dying from breast cancer will be half as much if she participates in screening as it would be if she fails to participate. She should also be aware that the smaller cancers detected at screening can often be removed by breast conserving surgery without the need for mastectomy. Because mammography does not prevent breast cancer, women must be aware of the fact that mammography has to be repeated at regular intervals if the benefits of screening are to be maintained. Additionally, breast self-examination should be practiced in the interval between screens. Finally, decision makers will have to realize that screening with mammography can, in the long run, lead to reduction of health service costs. It is obvious that the expenses involved in taking care of a patient with advanced breast carcinoma can be very high. As it has been clearly demonstrated that properly performed screening will significantly decrease the number of advanced, costly breast carcinomas, a large proportion of these expenses will be saved in the population invited to screening. Because screening itself drains economic resources, the costs of screening outweigh the savings until the number of advanced cancers decreases; however, after this occurs the expenses of screening will be far less than the savings. The savings arise from the smaller number of advanced, costly cases. The results to date are convincing enough to justify recommending large-scale mammographic screening. The Swedish government has recommended screening with mammography for all women aged 40-74. This recommendation repeatedly emphasizes the necessity of high quality examinations interpreted by well-trained radiologists.