[Breast cancer screening for women with a strong familial risk]

Screening for breast cancer in high-risk women could be seen through the general criteria for cancer screening. The attributable part of BRCA in breast cancer is estimated to be between 2 and 5%. For these women, breast cancer screening lay between prevention with low risk/benefit efficacy and prophylactic mastectomy with high efficacy but low acceptability. Risk reduction could be achieve with "classic" screening tools (examination, mammography and ultra sound) but should soon benefit from MRI experimental protocols. Later, combined imaging and biology protocols may solve the issue of screening in cancer prone women. A comprehensive program is required, taking in account both the competitive risk of ovarian cancer and the risk reduction observed at the breast level with prophylactic oophorectomy, at least in BRCA1 women. Information, and psychological help is all the more a necessity, since the lack of specificity of screening may induce harm, particularly for these women. Due to methodological flaws, the low power and a short follow-up of the surveys, this statement cannot however aspire to a high stability.