[Mammographic screening starting in the fifth or sixth decade of life]

Mammography is an established diagnostic procedure for breast cancer. Data concerning screening mammography are available from nine prospectively controlled trials, the largest series being presented from Sweden. Mammographic screening leads to a significant reduction of breast cancer of 30% in women ages 50-59 years. In younger women (40-49 years) the benefit accounts to only 20% and has not proven to be statistically significant. Nevertheless, the major advantage of mammographic screening is detection of the non-palpable tumor < or = 10 mm in size. The treatment of these small breast carcinomas leads to long-term survival rates of > or = 90%. Mammographic screening programs have been introduced in the USA, Canada, Iceland and Sweden for women in their 5th decade of life. Starting yearly lifelong mammography-screening at the age of 40, the theoretical cancer induction by radiation exposure does not exceed 0.1%. Under highly qualified conditions, it should be possible to minimize false-positive and false-negative screening results. In Germany, screening-mammography is only introduced in patients at high risk for breast cancer. Based on medical data, mammography must be a part of screening for women with an average risk--starting at the age of 40, although there are still open questions needing further clinical research.