The history and present status of radiographic screening for breast carcinoma

Many of the perceived and actual difficulties in the creation of screening centers have been solved or are amenable to solution. The amount of radiation delivered to the breast during mammography no longer poses a significant risk and there is ample evidence that screening mammography can detect occult disease. While substantial evidence is lacking with respect to a decrease in mortality in patients under 50 years of age, there is an unequivocal gain in those over 50 years of age. Other concerns center around the number of trained radiologists available to interpret large numbers of screening mammograms, the use of lay screeners to minimize the physician shortage and the availability of instruction centers to educate those radiologists not formally trained in mammography. The question of quality control is closely tied to the training of the radiologist and must be addressed if screening centers are to function efficiently. All of the above are correctable to a greater or lesser degree, but the problem of cost remains. To survey all women over 40 years of age at a cost of $50.00 per examination would require an expenditure in excess of two billion dollars a year, a staggering sum even in the context of the economy of the 1980s. It is necessary that these costs be lowered if the full potential of a major cancer detection procedure is to be realized. This conference has both the responsibility and opportunity to perform a significant service for the women of the US. We ask all of you to devote your greatest ingenuity to achieving its major purpose, the development of a practical strategy for cost reduction in mammography. While it may not be possible to achieve all that we wish, the formulation of any reasonable plan to increase public access will be a major accomplishment. I remind you of a French aphorism: "The greatest crime is to do nothing because we fear we can only do a little."