[Breast cancer screening: a better anamnesis and an informed choice]

The goal of this article is to compare breast cancer screening national and international guidelines for defining a pragmatic and evidence-based attitude for primary care professionals in Belgium. A literature review was made in the main guidelines databases and in the belgian epidemiological and reimbursement databases. The decrease in breast cancer mortality this last decade reduce the screening efficiency by the same extent. Finally, it is recommended to propose systematically mammotest screening between 50 and 70 and to inform the patients by messages developed for this purpose by the KCE. Based on a simple family history, we can define three risk groups (KCE - strong recommendation, moderate evidence level). Start this anamnesis from 30 years old, seems to be logical regards to the exams which have to be done if the risk is very elevated. If the risk is elevated, it is recommended to propose annual mammography between 40 and 49 (KCE - weak recommendation - very low evidence level). If the risk is very elevated, refer to the secondary care. Supplementary data are needed to appreciate the influence of social health determinant on the breast cancer morbidity and mortality and to improve our vision of the screening benefice-risk trade-off.