Climacteric : the journal of the International Menopause Society
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The evidence is reviewed on the efficacy and effectiveness of mammography screening derived from randomized screening trials and from the surveillance of populations where mammography screening for breast cancer has been introduced. Nearly all the trials were performed in the era before modern adjuvant therapy for breast cancer was introduced, apart from the Canadian National Breast Screening Study and the UK Age trial. ⋯ The evidence from population-based surveillance is mixed, most such studies having failed to consider the benefit gained from improved therapy. It is concluded that we have reached the point of negligible benefit from mammography screening for breast cancer in women at average risk, and that we should concentrate on early diagnosis of breast cancer and the application of modern therapy according to clearly defined sub-types of breast cancer.
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The estimated cervical cancer burden is over ten-fold greater in low- and middle-income countries (LMICs) than in high-income countries. This health gap is thought to be primarily due to limited access to effective screening and treatment programs for cervical pre-cancer and cancer in such settings. The World Health Organization advocates a policy of 'screen and treat' approach to cervical screening in LMICs and subsequently visual inspection of the cervix with acetic acid (VIA) or Lugo's iodine (VILI), followed by ablative cervical cryotherapy if indicated, and this policy has been implemented in many high-burden settings. ⋯ Recently, many high-income countries have integrated HPV-DNA testing into their cervical cancer screening programs. The comparatively high cost and resource requirements of HPV-based screening have to date prevented many LMICs from doing the same. A significant development has been the entrance of innovative, easy-to-use and highly accurate HPV tests that can be provided at point of care; these could enable LMICs to implement 'test and treat' approaches for cervical cancer screening.