Screening for Breast Cancer - Conclusion

The decision to screen women for breast cancer is based on the importance of the disease as a public health problem and the demonstrated ability of screening tests to meet acceptable levels of performance and reduce morbidity and mortality. However, although great progress has been made over the last decade, the full potential of breast cancer screening as a disease control strategy remains unfulfilled.

Although a majority of women aged 40 and older have had a mammogram, most women are not screened at recommended intervals. Data also suggest that improvements are needed to ensure timely screening according to recommended intervals. In the United States, screening is commonly opportunistic rather than organized, and access is still a significant problem for medically underserved women. Once the decision to screen has been reached, screening programs should be carefully monitored, and attention should be devoted to using results to improve performance.

In general, a breast cancer screening program must have high levels of participation and must achieve acceptable levels of performance in terms of sensitivity and specificity. More fundamentally, for screening to be effective, the program must reduce the incidence rate of advanced breast cancer in a population so that more successful treatment is assured. In the coming years, there must be renewed efforts to make the most of the technology at hand as we anticipate newer screening modalities and emerging preventive strategies.

Robert A. Smith and Carl J. D’Orsi

R. A. Smith: Cancer Screening, Department of Cancer Control, American Cancer Society, Atlanta, Georgia
C. J. D’Orsi: Diagnostic Radiology, University of Massachusetts Memorial Medical Center, Worchester, Massachusetts


1. Donegan WL. Introduction to the history of breast cancer. In: Donegan WL, Spratt JS, eds. Cancer of the breast. Philadelphia: WB Saunders, 1995:1.

2. Bassett LW, Gold RH, Kimme-Smith C. History of the technical development of mammography. In: Haus AG, Yaffe MJ, eds. Syllabus: a categorical course in physics: technical aspects of breast imaging. Chicago: Radiological Society of North America, 1993:9.

3. Shapiro S, Strax P, Venet L. Periodic breast cancer screening in reducing mortality from breast cancer. JAMA 1971;215:1777.

4. Baker L. Breast Cancer Detection Demonstration Project: five year summary report. CA Cancer J Clin 1982;32:196.

5. Smart CR, Byrne C, Smith RA, et al. Twenty-year follow-up of the breast cancers diagnosed during the Breast Cancer Detection Demonstration Project . CA Cancer J Clin 1997;47:134.

6. Hurley SF, Kaldor JM. The benefits and risks of mammographic screening for breast cancer. Epidemiol Rev 1992;14:101.

7. Tabar L, Fagerberg CJ, Gad A, et al. Reduction in mortality from breast cancer after mass screening with mammography. Randomised trial from the Breast Cancer Screening Working Group of the Swedish National Board of Health and Welfare. Lancet 1985;1:829.

8. Tabar L, Fagerberg G, Chen HH, et al. Efficacy of breast cancer screening by age. New results from the Swedish Two-County Trial. Cancer 1995;75:2507.

9. Tabar L, Duffy SW, Chen FM. Re: Quantitative interpretation of age-specific mortality reductions from the Swedish Breast Cancer-Screening Trials [Letter; comment]. J Natl Cancer Inst 1996;88:52.

10. Tabar L, Chen HH, Fagerberg G, Duffy SW, Smith TC. Recent results from the Swedish Two-County Trial: the effects of age, histologic type, and mode of detection on the efficacy of breast cancer screening. J Natl Cancer Inst Monogr 1997;22:43.

11. Calder K. Access to screening mammography: patient concerns about insurance. Women’s Health Issues 1992;2:189.

12. ...
Complete References

Provided by ArmMed Media