Breast cancer screening and management

Synopsis Mammographic screening to detect preclinical cancer was introduced when it was realised that once breast cancer became symptomatic it could not be cured regularly by local surgery, as early systemic dissemination had almost invariably occurred. Meta‐analysis of randomised controlled trials of screened versus unscreened women has demonstrated a mortality benefit approaching 30% in screened women (> 50 years of age) seven to nine years from the start of the trials. The UK and Australian breast screening programs are compared. Differences in the design are largely a result of differences in the healthcare systems in the two countries. Breast self‐examination, although still recommended by many Australian practitioners, is not an appropriate screening method, as it does not affect breast cancer death rates. About 5% of women have familial breast cancer (associated with mutations of BRCA1 or BRCA2). Women at high risk are screened at an earlier age and at more frequent intervals. Current best practice management of screen‐detected breast cancer, including surgery, radiotherapy, assessment of the axilla, and systemic therapy, is summarised. Women with symptomatic breast disease ideally should be treated by a specialised multidisciplinary service, which can provide sophisticated diagnosis and treatment as well as supportive care.