Screening for Breast Cancer: Opportunities, Status and Challenges

  • R. McLelland
Part of the Recent Results in Cancer Research book series (RECENTCANCER, volume 119)


I was taught that 95% of breast cancers are first found by the patient. More recent studies suggest that this has changed with increased and earlier detection by physicians on incidental physical examination of asymptomatic women’s breasts and the emerging benefit of screening mammography (Nemoto et al. 1982). As a consequence of this, and as patients have become more informed and optimistic with less self-denial and fear, we are seeing fewer locally advanced lesions.


Breast Cancer Natl Cancer Inst Breast Cancer Screening Screening Mammography Interval Cancer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. American Cancer Society (1983) Mammography guidelines 1983: background statement and update of cancer-related checkup guidelines for breast cancer detection in asymptomatic women age 40 to 49. CA 33 (4): 255Google Scholar
  2. American College of Radiology (1982) Guidelines for mammography. ACR Bull 38 (11): 6–7Google Scholar
  3. Angell M (1985) Cost containment and the physician. JAMA 254: 1203–1207PubMedCrossRefGoogle Scholar
  4. Anonymous (1980) The evaluation of early detection tests and procedures. CA 30 (4): 232–240Google Scholar
  5. Anonymous (1985) Survey of physicians’ attitudes and practices in early cancer detection. CA 35 (4): 197–213Google Scholar
  6. Anonymous (1984) Breast screening: new evidence. Lancet 1: 1217–1218Google Scholar
  7. Bailar J (1976) Mammography, a contrary view. Ann Intern Med 84: 77PubMedGoogle Scholar
  8. Baker LH (1982) Breast cancer detection demonstration project: five-year summary report. CA 32 (4): 194–225PubMedGoogle Scholar
  9. Bassett LW, Bunnell DH, Cerny JA, Gold RH (1985) Screening mammography: a survey of 4200 referring physicians—Radiology 157: 53Google Scholar
  10. Berg JW (1984) Clinical implications of risk factors for breast cancer. Cancer 53: 589–591PubMedCrossRefGoogle Scholar
  11. Bird RE, McLelland R (1986) How to initiate and operate a low-cost screening mammography center. Radiology 161: 43–47PubMedGoogle Scholar
  12. Cadman D, Chambers L, Feldman W, Sackett D (1985) Assessing the effectiveness of community screening programs. JAMA 251: 1580–1585CrossRefGoogle Scholar
  13. Carter PL and Gillespie JT (1984) Abnormal mammographic findings: a critical appraisal. Am J Surg 147: 638–640PubMedCrossRefGoogle Scholar
  14. Clayman CB (1980) Editorial. Mass screening: is it cost-effective? JAMA 243: 2067–2068PubMedCrossRefGoogle Scholar
  15. Collette HJA, Rombach JJ, Day NE, De Waard F (1984) Evaluation of screening for breast cancer in a non-randomized study ( The DOM Project) by means of a case-control study. Lancet 1: 1224–1226PubMedCrossRefGoogle Scholar
  16. Dowdy AH, Barker WF, Lagasse LD et al. (1971) Mammography as a screening method for the examination of large populations. Cancer 28: 1558–1562PubMedCrossRefGoogle Scholar
  17. Eddy DM (1983) A mathematical model on the efficacy of breast cancer screening. In: Feig SA, McLelland R (eds) Breast carcinoma: current diagnosis and treatment. ACR and Masson, New York, pp 339–349Google Scholar
  18. Feig SA (1983) Low dose mammography: assessment of theoretical risk. In: Feig SA, McLelland R (eds) Breast carcinoma: current diagnosis and treatment. ACR and Masson, New York, pp 69–76Google Scholar
  19. Feig SA (1983) Mammographic screening: benefit and risk. In: Feig SA, McLelland R (eds) Breast carcinoma: current diagnosis and treatment. ACR and Masson, New York, pp 351–363Google Scholar
  20. Feig SA (1986) Screening mammography: benefits and risks. In: Moskowitz M (ed) Breast imaging. Radiological Society of North America, Oak Brook, 111., pp 75–84Google Scholar
  21. Fisher B et al. (1969) Cancer of the breast: size of neoplasm and prognosis. Cancer 24: 1071–1080PubMedCrossRefGoogle Scholar
  22. Fletcher SW, O’Malley MS, Bunce LA (1985) Physicians’ abilities to detect lumps in silicone breast models. JAMA 253: 2224–2228PubMedCrossRefGoogle Scholar
  23. Fox MS (1979) On the diagnosis and treatment of breast cancer. JAMA 241: 489–494PubMedCrossRefGoogle Scholar
  24. Fox S, Baum JK, Klos DS, Tsou CV (1985) Breast cancer screening: the underuse of mammography. Radiology 156: 607–611PubMedGoogle Scholar
  25. Fraizer TG, Copeland EM, Gallager HS et al. (1977) Prognosis and treatment in minimal breast cancer. Am J Surg 133: 697–701CrossRefGoogle Scholar
  26. Gallager HS, Martin JE (1971) An orientation to the concept of minimal breast cancer. Cancer 28: 1505–1507CrossRefGoogle Scholar
  27. Gershon-Cohen J, Ingleby H, Berger SA (1967) Mammographic screening for breast cancer: results of 10 year survey. Radiology 88: 663PubMedGoogle Scholar
  28. Gilbertsen VA (1966a) Survival of asymptomatic breast cancer patients. Surg Gynecol Obstet 122: 81–83PubMedGoogle Scholar
  29. Gilbertsen VA (1966b) Improving breast cancer prognoses. Geriatrics 21: 128PubMedGoogle Scholar
  30. Gilbertsen VA, Kfelsberg IM (1971) Detection of breast cancer by periodic utilization of methods of physical diagnosis. Cancer 28: 1552–1556PubMedCrossRefGoogle Scholar
  31. Gohagen JK, Darby WP, Spitznagel EL et al. (1986) Radiogenic breast cancer effects of mammographic screening. J Natl Cancer Inst 77: 71–76Google Scholar
  32. Habbema JDF, Oartmarssen GJV, Putten DJV et al. (1986) Age-specific reduction in breast cancer mortality by screening: an analysis of the results of the Health Insurance Plan of Greater New York study. J Natl Cancer Inst 77: 317–320PubMedGoogle Scholar
  33. Hall FM (1986) Editorial: screening mammography. AJR 147: 195–197PubMedGoogle Scholar
  34. Holland R, Mravunac M, Hendriks JH, Bekker BY (1982) So-called interval cancers of the breast: pathologic and radiologic analysis of sixty-four cases. Cancer 49: 2527–2533PubMedCrossRefGoogle Scholar
  35. Holland R, Hendriks JH, Mravunac M (1983) Mammographically occult breast cancer. Cancer 52: 1810–1819PubMedCrossRefGoogle Scholar
  36. Howe GR (1984) Epidemiology of radiogenic breast cancer. In: Boice JD Jr, Fraumeni JF Jr (eds) Radiation carcinogenesis: epidemiology and biological significance. Raven, New York, pp 119–129Google Scholar
  37. Martin J, Moskowitz M, Milbrath JR (1979) Breast cancer missed by mammography. AJR 132: 737–739PubMedGoogle Scholar
  38. McFarlane C, Sturgis MC, Fetterman FS (1955) Results of an experiment in the control of cancer of the female pelvic organs and report of a fifteen-year research. Am J Obst Gynecol 69: 294Google Scholar
  39. McLelland R (1978) Mammography in the detection, diagnosis and management of carcinoma of the breast. Surg Gynecol Obstet 146: 735–740PubMedGoogle Scholar
  40. McLelland R (1984) Mammography 1984: challenge to radiology. AJR 143: 1–4PubMedGoogle Scholar
  41. McLelland R (1987) Low-cost mass screening with mammography as a means of reducing overall mortality from breast cancer. Radiol Clin North Am 25: 1007–1013PubMedGoogle Scholar
  42. McLelland R, Feig SA (1983) Guidelines for mammography. In: Feig SA, McLelland R (eds) Breast carcinoma: current diagnosis and treatment. ACR and Masson, New York, pp 365–369Google Scholar
  43. Moskowitz M (1984) Mammography to screen asymptomatic women for breast cancer. AJR 143: 457–459PubMedGoogle Scholar
  44. Moskowitz M (1986) Breast cancer: age-specific growth rates and screening strategies. Radiology 161: 37–41PubMedGoogle Scholar
  45. Nemoto T, Natarajan N, Smart CR et al. (1982) Patterns of breast cancer detection in the United States. J Surg Oncol 21: 183–188PubMedCrossRefGoogle Scholar
  46. O’Malley MS, Fletcher SW (1987) Screening for breast cancer with breast self-examination. JAMA 257: 2197–2202Google Scholar
  47. Paul us DD (1982) Is the cost of mammography screening really worth it? Your Patient and Cancer 2: 47–49Google Scholar
  48. Phillips MA, Miller J (1952) Incidence of breast pathology in well women. IMJ 102: 176Google Scholar
  49. Saltzstein SL (1984) Potential limits of physical examination and breast self-examination in detecting small cancers of the breast: an unselected population-based study of 1302 cases. Cancer 54: 1443–1446PubMedCrossRefGoogle Scholar
  50. Seidman H, Mushinski MH (1983) Breast cancer: incidence, mortality, survival, and prognosis. In: Feig SA, McLelland R (eds) Breast carcinoma: current diagnosis and treatment, ACR and Masson, New York, pp 9–46Google Scholar
  51. Seidman H, Gelb SK, Silverberg E et al. (1987) Survival experience in the Breast Cancer Detection Demonstration Project. CA 37: 258–290PubMedGoogle Scholar
  52. Shapiro S (1977) Evidence on screening for breast cancer from a randomized trial. Cancer 39 (Suppl): 2772–2782PubMedCrossRefGoogle Scholar
  53. Shapiro S et al. (1982) Ten-to fourteen-year effect of screening on breast cancer mortality. J Natl Cancer Inst 69: 349–355PubMedGoogle Scholar
  54. Shapiro S, Venet W, Strax P et al. (1985) Selection, follow-up, and analysis in the Health Insurance Plan study: a randomized trial with breast cancer screening. Natl Cancer Inst Monogr 67: 65–74PubMedGoogle Scholar
  55. Skrabanek P (1985) Screening for disease: false premises and false promises of breast cancer screening. Lancet 1: 316–320CrossRefGoogle Scholar
  56. Soffer A (1985) Cost-effective or quality care. Which shall it be? Arch Intern Med 145: 1963–1964 (editorial)Google Scholar
  57. Stevens GM, Weigen JF (1966) Mammography survey for breast cancer detection. Cancer 19: 51–59PubMedCrossRefGoogle Scholar
  58. Tabar L, Gad A, Holmberg LH et al. (1985) Reduction in mortality: from breast cancer after screening with mammography. Lancet 1 (8433): 829–832PubMedCrossRefGoogle Scholar
  59. Thier SO (1977) Breast cancer screening: a view from outside the controversy. N Engl J Med 297: 1063–1065 (editorial)Google Scholar
  60. Tokumaga M, Land CE, Yamamoto et al. (1984) Breast cancer among atomic bomb survivors. In: Boice JD, Fraumeni JF (eds) Radiation carcinogenesis: epidemiology and biological significance. Raven, New York, pp 45–46Google Scholar
  61. Upton AC, Beebe GW, Brown JW et al. (1977) Report of the NCI ad hoc working group on the risks associated with mammography in mass screening for the detection of breast cancer. J Natl Cancer Inst 59: 481–493Google Scholar
  62. Verbeek ALMJ, Holland R, Sturmans F et al. (1984) Reduction of breast cancer mortality through mass screening with modern mammography. Lancet 1: 1222–1224PubMedCrossRefGoogle Scholar
  63. Wanebo HJ, Huvos AG, Urban JA (1974) Treatment of minimal breast cancer. Cancer 33: 349–357PubMedCrossRefGoogle Scholar
  64. Witten DM, Thuber DL (1964) Mammography as a routine screening examination for detecting breast cancer. AJR 92: 14–21Google Scholar
  65. Wolfe JN (1964) Mammography: report of its use in women with breasts abnormal and normal on physical examination. Radiology 83: 244–254PubMedGoogle Scholar
  66. Wright CJ (1986) Breast cancer screening: a different look at the evidence. Surgery 100: 594–598PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1990

Authors and Affiliations

  • R. McLelland
    • 1
  1. 1.Department of RadiologyUniversity of North Carolina School of MedicineChapel HillUSA

Personalised recommendations