Mammography: a critical evaluation of its role in breast cancer screening, especially in developing countries.
Screening for breast cancer using mammography alone, or mammography plus physical examination of the breasts, reduces mortality from breast cancer in women age 50-69. The evidence for effectiveness in older women is less clear. If effective in younger women, benefit is delayed compared to that seen in women age 50 or more. The increasing incidence of breast cancer in developing countries, and the late stage at diagnosis of most disease, supports efforts to introduce screening for breast cancer. However, the requirements of mammography in terms of technology and skilled personnel make it difficult to apply in most developing countries at present. There is a need to evaluate simpler screening tests, such as physical examination of the breasts and breast self-examination, as they can be applied by existing health personnel, and more readily integrated into medical care.