Chapter 1: Screening, diagnosis & staging of breast cancer and multidisciplinary team working
Breast cancer screening
The European Commission Initiative on Breast Cancer (ECIBC) Guidelines Development Group strongly recommends organised mammography screening for asymptomatic women aged 50–69, and conditionally for women aged 45–49 or 70–74.
The ECIBC suggests mammography screening every 2 to 3 years for women aged 45–49, every 2 years at age 50–69, every 3 years at age 70–74.
Figure 1.16: Proportion of women who had received a mammogram within the 2 years prior to the reference year (% of women aged 50 to 69, 2019).
Credit: European Union, Eurostat.
According to EuroStat, about two thirds of women aged 50–69 had received a mammogram within two years in the European Union in 2019.
In organised mammography screening, mammograms are recommended to be read independently by two radiologists (double screening) to increase cancer detection rate.
Figure 1.17: Conventional mammography and tomosynthesis.
Credit: courtesy of H. Joensuu.
The ECIBC suggests using either digital mammography or digital breast tomosynthesis (a pseudo-3D imaging technique).
Detection of cancer is more difficult when the breast density is high. When high breast density is found at the first imaging, digital breast tomosynthesis may be the preferred technique for the next screening rounds.
BC screening allows detection of asymptomatic cancers when tumour size is still small. This may allow less extensive surgery and abolish the need for (neo)adjuvant treatments.
The exact efficacy of mammography screening on BC mortality reduction rate is unknown, as the estimates vary. In the 50–69-years age group, the estimated relative BC mortality reduction rate is about 20%.
Figure 1.18: Mammogram from dense and fatty breast.
Credit: Dr Mazen Sudah, Department of Radiology, Kuopio University Hospital, Dr Katja Hukkinen, Department of Radiology, Helsinki University Hospital and Dr Päivi Heikkilä, Department of Pathology, Helsinki University Hospital.
The estimated BC mortality reduction rate is probably slightly inferior in the age group 45–49 years, due to greater breast density.
Revision questions
- At what age is organised mammography screening strongly recommended?
- What is digital breast tomosynthesis?
- By how much, as a percentage, does mammography screening reduce BC mortality?
