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In the UK, breast cancer represents the most commonly diagnosed cancer in females and carries with it a significant morbidity and mortality. An established national screening programme is in place to identify those with the disease at an early stage in order to optimise treatment and prognosis. This article provides an overview for the non-breast specialist clinician whose practice regularly deals with women who may be the subject of the screening programme. It outlines the diagnostic methods employed in the screening programme, the controversies that have surrounded it and the evolving technologies that will improve detection and diagnostic accuracy.

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It is now widely recognised that the use of hormone replacement therapy (HRT) can influence mammographic pattern. Approximately 17-24% of women using HRT may have demonstrable changes on sequential mammography consisting either of a generalised increase in background density or focal changes such as cyst formation or an increase in the size of fibroadenomata. In addition to demonstrable change, HRT may also lead to maintenance of breast density, so that the natural

The Swedish Two-County Trial is a randomized controlled study of invitation to breast cancer screening. It was initiated in late 1977. The follow-up to the end of 1998 provides results at approximately the twentieth anniversary of the trial. A significant decrease in breast cancer death among women invited to screening was published 7-8 years after randomization and at 20-year follow up there is a significant 32% reduction in mortality associated with invitation to screening. The advent of screen-film mammographic screening with the ability to detect potentially fatal tumors at an early stage provides an opportunity to study the natural history of breast cancer at an earlier phase in its development than was possible in the past. Our findings show that breast cancer is not a systemic disease at its inception, but is a progressive disease and its development can be arrested by screening. Detection of < 15 mm and lymph node negative invasive tumors will save lives and confer an opportunity for less radical treatment.