18 - Control of Breast Cancer. The Past and the Present.

For centuries women have brought their palpable breast tumors to the attention of their physicians, by which time these tumors were mostly far advanced. Advanced breast cancer is more likely to be associated with systemic disease at the time of diagnosis and treatment.  Consequently, advanced disease is strongly associated with breast cancer death.

• Our generation of physicians has made the commitment to improve the outcome of the breast cancer patients significantly through early detection of breast cancer.
• There is unequivocal supporting evidence from well conducted prospective randomized controlled trials that decreasing the incidence rate of advanced tumors through screening will result in a corresponding decrease in breast cancer mortality in this same group of women. The introduction and practice of systematic early detection of breast cancer through mammography screening has shifted the size distribution of detected breast cancers from mainly palpable to largely non-palpable cancers.
• After extensive research for decades, we can conclude that of all the alleged harms associated with breast cancer screening, the greatest harm comes from non-attendance.
• The scientific establishment and health care professionals who care for breast cancer patients are aware that the decisive factor is whether the treatment is given early or late in the natural history of the disease, rather than which treatment choice is offered to breast cancer patients.

High quality mammography screening can be considered a major public health achievement, the most important control mechanism for breast cancer deaths ever invented.