Do we still need breast cancer screening in the era of targeted therapies and precision medicine?

Abstract

Breast cancer (BC) is the most common female cancer and the second cause of death among women worldwide. The 5-year relative survival rate recently improved up to 90% due to increased population coverage and women’s attendance to organised mammography screening as well as to advances in therapies, especially systemic treatments. Screening attendance is associated with a mortality reduction of at least 30% and a 40% lower risk of advanced disease. The stage at diagnosis remains the strongest predictor of recurrences. Systemic treatments evolved dramatically over the last 20 years: aromatase inhibitors improved the treatment of early-stage luminal BC; targeted monoclonal antibodies changed the natural history of anti-human epidermal growth factor receptor 2-positive (HER2) disease; immunotherapy is currently investigated in patients with triple-negative BC; gene expression profiling is now used with the aim of personalising systemic treatments. In the era of precision medicine, it is a challenging task to define the relative contribution of early diagnosis by screening mammography and systemic treatments in determining BC survival. Estimated contributions before 2000 were 46% for screening and 54% for treatment advances and after 2000, 37% and 63%, respectively. A model showed that the 10-year recurrence rate would be 30% and 25% using respectively chemotherapy or novel treatments in the absence of screening, but would drop to 19% and 15% respectively if associated with mammography screening. Early detection per se has not a curative intent and systemic treatment has limited benefit on advanced stages. Both screening mammography and systemic therapies continue to positively contribute to BC prognosis.

Breast Cancer Screening Practice and Associated Factors Among Women Aged 20–70 Years in Urban Settings of SNNPR, Ethiopia

“…The women who attended an organized mammography screening increased the five-year relative survival rate up to 90%. 9 …”

“…The women who attended an organized mammography screening increased the five-year relative survival rate up to 90%. 9 In developing countries with very limited health system capacity and lack of early-detection programs, the potential number of women with breast cancer are diagnosed in the late stages and the overall five-year survival rate is very low, with a range of 10−40%. 10 Irrespective of the ongoing conflict points on the benefits and harms of BCS, various experts have belief in that the benefits of breast cancer screening outweigh the harm.…”

Circular RNAs: Their Role in the Pathogenesis and Orchestration of Breast Cancer

“…Breast cancer (BC) is the most frequently occurring malignancy and the leading cause of cancer-related death among women worldwide. In the last decade, despite therapies, such as surgery, radiation, chemotherapy, endocrine therapy, targeted therapy, and immunotherapy, have achieved certain curative effect, the incidence rates for BC have been rising over the world (Trimboli et al, 2020 ). The high mortality rates in BC patients are associated with recurrence and metastatic progression to distant organs, including the bone, lung, brain, and liver.…”

MRI-Derived Tumour-to-Breast Volume Is Associated with the Extent of Breast Surgery

“…Over the years, improvements in breast cancer care have been driven by advances in prevention and treatment [ 1 , 2 ]. The management of early-stage breast cancer reached a turning point when Halsted mastectomy was gradually replaced by breast-conserving surgery, followed by whole-breast radiation therapy (i.e., breast-conserving treatment), as a consequence of large randomized trials conducted in the 1970s and 1980s [ 3 , 4 , 5 , 6 ].…”