Breast Cancer Screening: Can We Justify Deescalation?

Area of Science:

• Oncology
• Radiology
• Public Health

Background:

• Novel breast cancer screening methods are widely adopted to decrease mortality.
• Tumor detection rates have increased, but this has not been validated as a surrogate for mortality reduction.
• Increased detection of occult cancers raises concerns about overdiagnosis.

Purpose of the Study:

• To evaluate the necessity of current breast cancer screening practices in light of therapeutic advancements.
• To propose a randomized trial comparing mammography and clinical breast examination (CBE) for breast cancer mortality.
• To explore the potential role of ultrasound in enhancing CBE during screening.

Main Methods:

• A randomized trial is proposed to compare screening mammography versus screening clinical breast examination (CBE).
• The primary endpoint for this trial would be breast cancer mortality.
• Hand-held ultrasound may be utilized to assist in interpreting CBE findings.

Main Results:

• Increased detection of occult tumors does not equate to validated reduction in breast cancer mortality.
• Advances in breast cancer therapy may allow for the cure of cancers detected later, challenging the necessity of early occult tumor detection.
• Overdiagnosis, the detection of non-life-threatening tumors, is a significant risk associated with current screening practices.

Conclusions:

• Recent improvements in breast cancer treatment justify reassessing and potentially deescalating screening protocols.
• A randomized trial comparing mammography and CBE with mortality as the endpoint is warranted.
• Deescalating breast cancer screening may mitigate the risks of overdiagnosis while maintaining or improving patient outcomes.