Screening and Early Detection
Europa Donna advocates for all European women to have access to nationwide population-based mammography screening programmes conducted in accordance with the European Guidelines on Breast Cancer Screening and Diagnosis developed by the European Commission Initiative on Breast Cancer (ECIBC), which are updated regularly based on the latest scientific evidence. Screening should be provided by specialised breast cancer services/centres that fulfil European quality and safety requirements as set out by the ECIBC.
Detecting breast cancer at its earliest stages increases a woman’s chances of survival and can reduce the need for certain more aggressive therapies.
Mammography is widely accepted as the best method to detect breast cancer early, before it becomes palpable. When carried out according to European guidelines it is the best standard form of early detection available today and the scientific evidence shows that it improves mortality rates from the disease. The European guidelines recommend that digital mammography or digital breast tomosynthesis be used in organised screening programmes for asymptomatic women with an average risk of breast cancer*.
Digital mammography is an imaging technique that creates 2D X-ray images of the breast and stores them in a computer. This method is preferred over film mammography as the images can be manipulated for optimal viewing, can be shared for further opinions, and has a lower radiation dose. Radiologists check the images for irregularities and compare them against previous mammograms for changes.
Digital breast tomosynthesis is a pseudo-3D imaging technique based on a series of low dose images of the breast from different angles. This method has the potential to heighten visualization and overcome tissue superposition, thus improving detection of breast lesions.
Before Screening: The Invitation
Mammography screening programmes should be population-based, where healthy (ie, asymptomatic) women in the general population are invited to come for screening.
The European guidelines recommend screening in all women aged 45 to 74 years. For those aged 50 to 69 screening is recommended every 2 years; for age 45 to 49 years, every 2 to 3 years; for age 70 to 74, every 3 years.
According to European guideline recommendations, women should be invited by letter, and if electronic means are used, this should be followed up by an SMS notification or an automated phone call.
See the European guideline recommendation*.
Women should be informed of the benefits and possible harm of screening using decision aids, such as printed materials or webpages describing outcomes of screening and their chances of occurring. See the European guideline recommendation*.
After Screening: Possible Results
The most common and likely result of mammography screening is a negative result (ie, no signs of breast cancer).
According to European guidelines, women should receive a letter and be informed as soon as possible, but no later than 30 days.
If anything suspicious is detected, further assessment is needed to make sure that only clinically relevant lesions are treated. Women should receive a letter and a phone call to be invited for further testing. This includes digital breast tomosynthesis, and if a biopsy is needed, this should be needle core biopsy or stereotactic-guided needle core biopsy, depending on the lesion type. Testing should be provided by quality-assured breast cancer services.
Special Populations in the European Guidelines
Special Populations in the European Guidelines
The ECIBC’s European Guidelines on Breast Cancer Screening and Diagnosis are for screening in asymptomatic women of average breast cancer risk.
European guidelines recommend organised screening every 2 to 3 years in women aged 45 to 49, and no screening in women 40-44.
ECIBC guidelines recommend organised mammography screening every 3 years in women aged 70 to 74.
See the European guideline recommendation*
Women with Dense Breasts
European guidelines recommend no extra screening in women with dense breasts (eg, with ultrasound or MRI), but those aged 45 to 74 who are asymptomatic and know they have dense breasts from previous screening tests should have digital breast tomosynthesis. High breast density is considered a risk for breast cancer because lesions can be difficult to detect.
Women at Higher Risk for Breast Cancer
Some women are considered to have a higher than average risk for breast cancer and require personalised monitoring outside a population-based screening programme. This includes women with a family history of breast cancer and BRCA1 and BRCA2 mutation carriers. The European Society of Medical Oncology (ESMO) recommends annual MRI and annual mammography (the same year or alternating years) in women with a strong familial history of breast cancer, with or without proven BRCA mutations.
See also the Hereditary Breast Cancer section
The Importance of Early Detection
Breast cancer incidence has increased since the introduction of mammography screening and continues to grow with the ageing of the population. Yet, in many countries, the mortality rate has decreased in recent years because of earlier detection and improved treatment through population-based mammography screening and awareness programmes.
See Breast Cancer Facts section
Mammography screening for women aged 45 to 74 years old is recommended because there are greater benefits than harms.
The risk of dying from breast cancer is reduced and the risk of developing breast cancer in stage III or greater may be reduced. Screening every 2 or 3 years, depending on the age group, is recommended over annual screening because this reduces chances of overdiagnosis (eg, unnecessary biopsies and anxiety).
Detecting breast cancer in its early stages helps provide treatment earlier before the disease can become invasive and affect vital tissue and organs. It can also reduce the need for more aggressive therapies with more adverse effects.
- Early Breast Cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
- European Commission. Cancer Screening: Improving Cancer Prevention Across the EU
- European Guidelines on Breast Cancer Screening and Diagnosis
- European Quality Assurance Scheme for Breast Cancer Services
- European Society of Breast Cancer Specialists (EUSOMA). The requirements of a specialist breast centre. The Breast 2020;51: 65-84.
- International Agency for Research on Cancer (IARC). Cancer Screening in Five Continents (CanScreen5)