Screening for breast cancer in Europe: achievements, problems, and future.

Several breast cancer screening programmes are being carried out in Europe. Clinical examination in combination with mammography is the screening method used in Guildford and Edinburgh (United Kingdom) as well as in Utrecht (Netherlands). Mammography is the only screening modality in the Swedish programmes of Falun (Kopparberg County), Linköping (Ostergötland county), and Malmö and in Nijmegen (Netherlands). Clinical examination is the initial screening method in Turku (Finland). The Swedish programmes are population-based, controlled, and randomised. They are designed to assess the impact of screening on the mortality of breast carcinoma. Comparing the results of all the European screening programmes is expected to give some answers to the hitherto unanswered questions concerning the screening method and ideal interval in different age groups. The results achieved so far indicate that although mammography is a sensitive method for the detection of early breast cancer, clinical examination and an aggressive biopsy policy may be necessary to reduce mortality from breast cancer in certain age groups. It is also evident that there is no universally applicable ideal screening method or rescreening interval for all age groups.