Mammography and breast cancer:: the new era

Objectives: To review the evidence demonstrating that early detection of breast cancer substantially decreases death from the disease. and to demonstrate that the significant change in the outcome of breast cancer patients results from a combination of early detection and surgical removal of breast cancer, as treatment of the late stage disease provides little impact on ultimate outcome. Method: Review results of the randomized controlled trials of mammographic screening and the published results of service screening. Results: Both randomized controlled trials and service screening, when performed properly, provide unequivocal evidence demonstrating that arresting the disease in its preclinically detectable phase has significant impact on outcome. Primary emphasis should be upon preventing breast cancer from developing to metastatic disease. Conclusions: Numerous scientific trials have repeatedly and convincingly confirmed that breast cancer is progressive rather than a systemic disease from its inception. Progression of breast cancer can be arrested through detection and treatment at an early phase. The time at which disease progression is arrested has significant impact on clinical outcome, making mammographic screening a key factor in the control of breast cancer. (C) 2003 International Federation of Gynecology and Obstetrics. Published by Elsevier Science Ireland Ltd. All rights reserved.