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Screening for breast cancer: is it globally applicable?

Nature Clinical Practice Oncology volume 5, pages 60–61 (2008)Cite this article

Although intuitively appealing, breast cancer screening is a complex public health intervention that is accompanied by varying degrees of over diagnosis and associated adverse consequences. Almost two decades after conclusion of the major randomized trials that tested the efficacy of screening mammography, and at a time when most developed countries around the world have adopted it as a public health measure, this screening procedure continues to invite controversy. The voices of consumer advocates are becoming shriller with the accusation that women are not being fully informed of the harmful effects of mammography and are being recruited for screening more by coercion than through informed choice.1,2 On the other hand, those responsible for running state-funded screening programs need to meet a minimum target of more than 70% compliance if population screening with mammography is to be cost-effective.3 Most mid-income and low-income countries do not have breast screening programs in place, although opportunistic screening continues sporadically in many of them. Should breast screening be globally implemented? If so, what are the issues that need to be addressed?

Firstly, is there sufficient awareness about the hazards of breast cancer in the community in question? Since screening should, by definition, be voluntary, can women be expected to volunteer for screening in the absence of a high level of awareness? If not, what degree of persuasion is acceptable? Additionally, what level of compliance is needed to make a breast-screening program cost-effective under the local socio-economic and cultural conditions? A relatively high level of compliance is essential, not only at the time of recruitment, but at every subsequent stage of a screening program, including attendance for the screening procedure, attendance at a referral hospital for further investigations and, if a suspicious lesion is detected, compliance to the prescribed treatment, which can often be prolonged. If cancer is confirmed, the entire course of treatment must be completed, and finally, the patient must attend follow-up appointments. In communities where the demands of daily living and earning a daily wage take precedence over worrying about breast cancer, the above steps of compliance may not be met.

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  1. Department of Surgical Oncology, Sir Ganga Ram Hospital, Rajendra Nagar, New Delhi 110060, India imittra@vsnl.com

Authors and Affiliations

  1. I Mittra is a Senior Consultant in the Department of Surgical Oncology, Sir Ganga Ram Hospital, New Delhi, India.,

    Indraneel Mittra

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Mittra, I. Screening for breast cancer: is it globally applicable?. Nat Rev Clin Oncol 5, 60–61 (2008). https://doi.org/10.1038/ncponc1019

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