[Breast cancer screening : present situation and prospects].

Breast cancer screening is a public health challenge. Belgium has the worldwide highest age-standardized breast cancer incidence. It ranks third in terms of specific mortality. The causes are unclear and presumably multifactorial. Like most European countries, Belgium has set up a screening program since 2001. Despite coverage rates varying from one Region to another, the annual 2 % specific mortality decline (observed in the vast majority of European countries) is the same. The age-based screening programs recommended by the European Union are often debated for their questionable impact on mortality and on incidence of advanced tumors (stages II and beyond), and for the harms they may generates (over-diagnosis, false positives). A risk-stratified screening strategy considering other well-documented risk factors (family history, breast density, and genetic variants) could lead to better results while reducing the disadvantages. This hypothesis will be tested through the European My Personal Breast Screening (My PeBS) study, a multicenter randomized clinical trial involving 85,000 volunteers.