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Mammography and beyond: developing technologies for the early detection of breast cancer

DOI: 10.1186/bcr429

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Following a short presentation of the history of mammography, the theory of efficacy evaluation through randomized clinical trials (all referenced) and the more recent evaluations of screening programmes that are ongoing in several countries are critically re-examined. The second chapter discusses new developments in breast imaging and in related technologies; a table presents the current status of imaging technologies for a large number of devices, few of which are currently of interest with regard to early detection. Most of the technologies discussed pertain to clinical diagnosis, and are unlikely to surpass mammography in the field of early detection in the near future.A chapter entitled Technologies in development: genetic and tumor markers reports on the progress that has been made in this important field, but it states that "... the ability to predict who will develop breast cancer is modest at best." We are still in the realm of basic research, and application of these technologies in screening is far from reaching routine daily practice. However, the authors emphasize the opportunity to improve predictive oncology in the early stages of breast cancer. Furthermore, with private companies developing genetic tests, and the fact that "The tests are not subject to FDA [Food and Drug Administration] regulation and thus clinical validity and utility did not have to be documented before entry into the market", there is a need for a new policy and for genetic counselling for women who request testing.The following chapter on the development and regulation of new technologies (which is referred to only within the context of the USA) is original to the best of my knowledge, at least for a European audience. The narrative of the initiatives and collaborations that have been active between government agencies, private industries and associations, and the examples of funding mechanisms for medical technology development confirm the massive investment into breast cancer c

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