Screening for breast cancer -is there an alternative to mammography?

Given the continuing increase in mammary cancer incidence and in many cases also mortality across the world, as well as the difficulty with primary prevention, the question of whether screening for early detection is effective is of prime importance. If there is a real benefit in terms of reduced mortality then attention should clearly be focused on the modality which should be recommended in different resource settings. In the developed world where mammography is generally available the results are less than conclusive. It seems possible that there is a segment of breast cancer benefited both by screening and by treatment, and that far from these effects being additive, they affect the same spectrum of cases, so that as treatment improves, the benefit we can expect to see from screening falls. In the Asian Pacific setting, randomized trials on the basis of the cost and benefit should be a high priority. However, the lesson from all programmes of breast screening, is that for success, attention has to be paid to all aspects of the programme, compliance with screening, high quality screening tests, quality in the referral, diagnosis and treatment process, as well as adequate follow-up.