Mammography Screening

Abstract

Breast cancer screening with mammography is a validated and effective method, with a mortality reduction among women attending the program in the range of 25–45%. European guidelines recommend biannual screening for women 50–69 years, but target groups vary somewhat among countries. American societies recommend annual screening, often from the age of 40. The goal of mammographic screening is to detect small node-negative cancers, and according to guidelines, at least 50% of screen-detected cancers should be less than 15 mm. Detection of small invasive cancers is a difficult task and a great challenge. In order to have a high cancer detection rate and a low recall rate, independent double reading with consensus or arbitration is a common approach in Europe. Full-field digital mammography (FFDM) is the current standard examination for screening of women at average risk. Conventional mammography has two serious limitations: low specificity and sensitivity in women with dense breasts. Ongoing discussion is whether the current practice of FFDM for all women (“one-size-fits-all” concept) should be replaced by “personalized” screening also for women at average risk. Implementation of advanced techniques for population-based screening is, however, a great problem and challenge. Adjunct ultrasound has so far been most used. Other potential modalities for supplemental screening include MRI and digital breast tomosynthesis. Adverse effects of mammography screening (radiation exposure, false positives, false negatives, and overdiagnosis) should be kept as low as possible in order to optimize the balance between benefit and harms of breast cancer screening.