ABSTRACT

Breast cancer is a leading cause of mortality among North American women regardless of race or ethnicity. Screening and therapy advancements1,2 lead the charge in the breast cancer mortality decline since 1990.3 Several recent reports document screening mammography’s impact on breast cancer survival. Smith et al.4 evaluated the clinical presentation and outcome of 6000 Michigan women diagnosed with breast cancer. In this study, mammography detected 65% of breast cancers. e parameters of patient age and cancer stage at the time of diagnosis stratify the patients. In women less than 50 years of age, mammography detected less than half of the breast cancers. e authors note that the screen-detected cancers had favorable prognostic indicators including (1) earlier stage, (2) lower tumor grade, (3) fewer mastectomies (27% with screen-detected cancers vs. 46% with cancers presenting with palpable ndings), and (4) less chemotherapy requirements. In fact, the authors conclude that when patients or physicians nd cancer on physical examination, it is more often due to advanced cancers that may require mastectomies. Further, in one of largest randomized controlled breast screening trials, Tabar et al. report a 30% decline in mortality when women undergo regular screening mammography.5