A new era in the diagnosis and treatment of breast cancer
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Published on: August 19, 2025
1Department of Mammography, Falun Central Hospital, Falun, Sweden. laszlo@mammographyed.com
Abstract:
Randomized controlled mammography screening trials and the evaluation of service screening have unequivocally proven that regular mammography screening significantly reduces mortality from breast cancer. This evidence contradicts the theory of Fisher, claiming that breast cancer is a systemic disease from its inception and undermines the justification for systemic therapy in most screen-detected cancers, because they are still localized to the breast and can be cured by local treatment alone. When high quality mammographic screening is offered at regular intervals to 40- to 74- year-old women, over 50% of the invasive cancers will be detected in the size range of 1-14 mm, fewer than 20% will be axillary node positive, and only about 20% will be poorly differentiated. This predominance of early-stage disease has created a revolutionary new era for those involved in the diagnosis and treatment of patients with breast cancer.
Insights
Regular mammography screening significantly reduces breast cancer mortality. Early detection through screening leads to smaller tumors and less node involvement, enabling curative local treatment.
Area of Science:
- Oncology
- Radiology
- Public Health
Background:
- Mammography screening trials have established its efficacy in reducing breast cancer mortality.
- The effectiveness of screening challenges theories suggesting breast cancer is systemic from onset.
Purpose of the Study:
- To highlight the impact of mammography screening on breast cancer detection and outcomes.
- To underscore the shift towards treating localized breast cancer effectively.
Main Methods:
- Analysis of data from randomized controlled mammography screening trials.
- Evaluation of service screening programs for breast cancer.
Main Results:
- Over 50% of invasive cancers detected are small (1-14 mm).
- Fewer than 20% of screen-detected cancers have positive axillary nodes.
- Approximately 20% of screen-detected cancers are poorly differentiated.
Conclusions:
- Mammography screening enables early detection of breast cancer.
- Early-stage detection facilitates curative local treatment, challenging the necessity of systemic therapy for all screen-detected cancers.
- Screening has revolutionized breast cancer diagnosis and treatment paradigms.
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