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

Insights into Imaging

Nicolò Matteo Luca Battisti¹  Rubina Manuela Trimboli²  Andrea Cozzi²  Moreno Zanardo²  Francesco Sardanelli³  Paolo Giorgi Rossi⁴  Veronica Magni⁵ 

[1] Breast Unit–Department of Medicine, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, London, UK;Breast Cancer Research Division, The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, London, UK;Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy;Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy;Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy;Epidemiology Unit, Azienda USL–IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy;Medical School, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy;

关键词: Breast neoplasms;    Mammography;    Cancer screening;    Prognosis;    Precision medicine;   

DOI  :  10.1186/s13244-020-00905-3

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY