The decision to screen women for breast cancer is based on the importance of the disease as a public health problem and the demonstrated ability of screening tests to meet acceptable levels of performance and reduce morbidity and mortality. However, although great progress has been made over the last decade, the full potential of breast cancer screening as a disease control strategy remains unfulfilled.

Although a majority of women aged 40 and older have had a mammogram, most women are not screened at recommended intervals. Data also suggest that improvements are needed to ensure timely screening according to recommended intervals. In the United States, screening is commonly opportunistic rather than organized, and access is still a significant problem for medically underserved women. Once the decision to screen has been reached, screening programs should be carefully monitored, and attention should be devoted to using results to improve performance.

In general, a breast cancer screening program must have high levels of participation and must achieve acceptable levels of performance in terms of sensitivity and specificity. More fundamentally, for screening to be effective, the program must reduce the incidence rate of advanced breast cancer in a population so that more successful treatment is assured. In the coming years, there must be renewed efforts to make the most of the technology at hand as we anticipate newer screening modalities and emerging preventive strategies.

Robert A. Smith and Carl J. D’Orsi

R. A. Smith: Cancer Screening, Department of Cancer Control, American Cancer Society, Atlanta, Georgia
C. J. D’Orsi: Diagnostic Radiology, University of Massachusetts Memorial Medical Center, Worchester, Massachusetts

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