IARC Handbooks of Cancer Prevention

Breast cancer screening



DOI 10.1002/cncr.11334

IARC handbooks of cancer prevention: breast cancer screening, VainioH, BianchiniF, editors. Lyon: IARC Press, 2002. Price: $40.00.

Stephen A. Feig M.D.*, * Mount Sinai Hospital, New York, New York.

Service screening mammography programs in Sweden have reduced breast cancer deaths by 50% in the eight counties where they were conducted. If other countries are to achieve similar success, their health care leaders will need to understand the reasons for the Swedish achievement as well as the shortcomings of programs that have shown smaller benefits. Part of a series published by the International Agency for Research on Cancer (IARC), IARC Handbooks on Cancer Prevention: Breast Cancer Screening is a guide for public health organizations that are considering, developing, conducting, or evaluating organized populationwide breast cancer screening programs. The book was written by a team of more than 25 international experts who met at the World Health Organization headquarters in Lyon, France, after spending the previous 13 months drafting and circulating sections of the report. The handbook consists of nine chapters.

The publication describes the worldwide burden of breast cancer and the biology, pathology, and natural history of the disease. Screening concepts such as lead time and sojourn time, as well as treatment guidelines for screen-detected breast cancer, are discussed. Although other textbooks often contain similar material, this first chapter is necessary to lay the groundwork for the unique perspective provided by the remainder of the IARC handbook.

The second chapter considers topics that are of vital importance to any organization planning a screening program. Recommendations for type and frequency of technical quality control tests for mammography are listed. The authors provide estimates for the sensitivity and specificity at screening programs in many different countries They list the potential strengths and limitations of imaging techniques other than conventional mammography. There is a very useful section on clinical breast examination and breast self-examination (BSE) including techniques and performance indicators.

Screening guidelines, program characteristics, performance indicators, and strategies to increase program attendance are found in Chapter 3.

The efficacy of screening, defined as the extent to which screening produces a beneficial result under ideal circumstances, is discussed in Chapter 4. Topics include characteristics of each of the screening trials and their impact on breast cancer mortality. Results from the Shanghai trial of BSE, as well as other BSE programs around the world, are also included.

Chapter 5 discusses the effectiveness of screening, i.e., how well screening has been implemented in terms of the ages of women screened, screening intervals, number of mammographic views, participation levels, detection rates, stage at detection, and interval cancer rates. Estimates for mortality reduction are made based on surrogate markers. The percentage of screening mammograms requiring further imaging, false-positive biopsy rates, psychologic stress from screening, and radiation risks are some of the other topics covered in this worldwide review of screening literature.

The material on cost-effectiveness in Chapter 6 should be extremely useful to policy planners, particularly because estimates differ according to the methods of calculation and economic circumstances in different countries. The final three brief chapters provide summaries, conclusions, and recommendations. These are followed by an extensive bibliography.

The unique value of the IARC handbook is that it reviews breast cancer screening from the perspective of public health policy. The publication contains international data that are otherwise not easily available from one comprehensive source.

Screening mammography can substantially reduce breast cancer mortality among all women 40 years and older in any country that is able to implement properly a program for early detection and treatment. This handbook should be invaluable in helping to plan programs that can achieve this goal.