Implementation of breast cancer screening.

Mammography, breast physical examination, and breast self-examination are recommended for breast cancer screening. Although in randomized trials of screening, mammography demonstrated a reduction in breast cancer mortality for women over 50, such data are not available for breast physical or self-examination. The Canadian National Breast Screening Study should provide data regarding the efficacy of breast physical examination alone. The World Health Organization has established trials to evaluate self-examination in the USSR and Germany. There is still controversy regarding routine mammographic screening and the optimal screening interval for women under age 50. The costs of mammographic screening remain a concern, but these costs can be lessened considerably through efficiency of mammographic services and a reduction in the number of false-positive interpretations that prompt biopsy. Primary care physicians can help to reduce breast cancer mortality by referring their patients for screening mammography and by performing breast physical examinations.