ABSTRACT
INTRODUCTION Over the past 50 years there have been major shifts in practice regarding the diagnosis and treatment of breast cancer, with trends away from radical surgical procedures to breast conserving treatment. The national screening programme in the United Kingdom has been active for almost 20 years, targeted at patients between the age of 50 and 64, but available to patients outside this age range under certain circumstances. It has planned to extend the screening age group up to age 73, which raises capacity and resource issues for screening centres. Mammography, ultrasound (US), and fi ne needle aspiration cytology (FNAC) have facilitated the diagnosis of small tumours, and US, FNAC, and sentinel node imaging can detect the nodal disease prior to or at the time of primary surgery. Imaging assessment and clinical examination now guide the decision to treat with neoadjuvant chemotherapy which has been shown to reduce the need for mastectomy ( 1 ). The role of imaging is crucial and well defi ned in the diagnosis of locoregional disease and nodal metastasis, but how it should be deployed in the staging of breast cancer and search for metastatic disease at the time of diagnosis has been less clear-cut. In particular, screening programmes tend to discover early-stage tumours and a balance must be struck to fi nd an appropriate level of imaging investigation.
