Review
. 2020 Sep;11(1).
doi: 10.1186/s13244-020-00905-3.

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

Rubina Manuela Trimboli 1 Paolo Giorgi Rossi 2 Nicolò Matteo Luca Battisti 3 Andrea Cozzi 4 Veronica Magni 5 Moreno Zanardo 4 Francesco Sardanelli 4 
Affiliations
  • PMID: 32975658
  •     72 References
  •     1 citations

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.

Keywords: Breast neoplasms; Cancer screening; Mammography; Precision medicine; Prognosis.

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