Detection and diagnosis of early breast cancer

Breast cancer mortality can be reduced by early detection and treatment, but the cost of diagnosis of early tumours from amongst the larger number of non-malignant disorders found as a result of public education and population screening is likely to be prohibitive, both economically and emotionally, as long as admission to hospital for biopsy and possible immediate mastectomy remains the major diagnostic policy. An alternative policy is proposed for the management of women with breast symptoms, which avoids operation on most patients without cancer and detects the smallest tumours, by means of mammography, fine-needle aspiration biopsy, large-needle biopsy and outpatient open biopsy. Such a policy is likely to provide positive reassurance with the least emotional distress for that majority of women with breast symptoms who do not have malignant disease, and this is likely to lead to more positive behaviour in the community such as regular breast self-examination and the early reporting of breast symptoms. Only women with malignant disease need be admitted to hospital for major breast surgery, thorough preoperative investigation could be confined to this group, and they could receive positive counselling to reduce their emotional stress. Such a policy is likely to be economical of health resources so that all women with breast symptoms and other risk factors could be encouraged to undergo annual examination, and any suspicious findings could be adequately investigated. In this way many more cancers could be detected while still small and curable, and a fall in breast cancer mortality in the community might be expected.