Test sequences in screening for breast cancer.

Published data of Stark and Way on the screening of 2,684 women at high risk of breast cancer are analyzed to arrive at a preferred sequence of screening tests. In the practical situation where palpation first signals a problem, the analysis suggests thermography to follow. Women with positive thermograms should then be biopsied, and those with negative thermograms should be mammographed. A positive mammogram calls for biopsy, and a negative one calls for close follow-up. For high-risk women whose breasts appear normal on palpation, a subsequent negative thermogram is not definitive enough to terminate investigation, but a negative mammogram after a negative palpation is enough evidence to waive further investigation for some time. A positive mammogram calls for immediate biopsy in any circumstance.