Radiation detection and diagnosis of breast cancer

The value of mammography in the symptomatic patient has been adequately documented, but its use as a detection procedure remains a question. Risk-benefit ratios, based primarily upon the study carried out by the Health Insurance Plan of Greater New York, have suggested that the technique has little value in individuals under age 50. Emphasis has been placed upon the possible carcinogenic effects of radiation as compared with the efficacy of mammography and the questionable influence of early diagnosis upon end results. Although technical advances have substantially reduced the exposure of the patient to radiation, the possibility of significant information loss as the result of these developments has been considered a potential drawback to their routine use. All of these factors have served to diminish both public and professional acceptance of the examination. Although current data do not allow complete resolution of these problems, certain conclusions may be drawn and trends established. The sum of these may indicate that minimal dose mammography is an accurate, low-risk procedure, capable of significantly altering the natural history of breast cancer. Whether or not the examination should be routinely used in women under age 50 remains open to question since the lack of experimental controls prohibits validation of the technique in terms of reduced mortality rates. Documentation of increased survival rates may partially assist in the established of a reliable risk-benefit ratio, but will not satisfy the statistical requirements of eliminating lead-bias, and self-selection. These questions may be resolved by studies now underway.