Individualized Breast Cancer Screening versus Population-based Mammography Screening Programs

A recent publication by Depypere et al. suggestthat instead of population-based breast cancerscreening, we should focus on individualized breastcancer screening. In fact this is a position statement 1by the European Menopause and AndropauseSociety (EMAS). This is not a new statement sincethis was under discussion now and then becausemany investigators believe that population-basedscreening programs cause overdiagnosis. Forexample, a new estimates of over-diagnosis of breastcancer due to population-based mammographyscreening in South Australia after adjustment forlead time effects showed that there were 8% overdiagnosisfor invasive breast cancer and 12%inclusive of ductal carcinoma in-situ due tomammography screening among women aged 40-84. However, the statement was received consider- 2able attentions by academics and practitioners. Forinstance, the statement was highlighted by somecancer societies and briefly summarized thestatement as follows:“Breast cancer is the most prevalent cancer inwomen. Mammography screening is a wellestablishedmethod to detect breast cancer. Howeverthere are concerns about over-diagnosis withpopulation-based screening programs. Some tumorsgrow so slowly that they will not threaten the healthof women during their lifetime. The women will diefrom another cause and thus it is argued that thesetumors should not have been treated. Treatments canbe invasive and painful, have major side effects,especially in those with significant co-morbidities.While this is easy from an epidemiologicalstandpoint, it is a dilemma for the treating physiciandealing with individual women. It is virtuallyimpossible to make the diagnosis of breast cancerand to predict the future behavior of that tumor. Thusindividualization is proposed so that women may becategorized into 'low to moderate' and 'high' riskbased on familial risk and the first screeningmammogram so that further screening can betailored”.