Primary prevention can help reduce a person's risk of contracting breast cancer

Several of the known risk factors for breast cancer are amenable to the following primary prevention measures:

1. breastfeeding children as long as possible;
2. limiting the consumption of alcoholic beverages to one drink per day;
3. avoiding prolonged use of exogenous sex-steroid hormones;
4. avoiding overweight particularly in post-menopause.

Mammography is the most effective type of breast cancer screening

Mammography has been proven to be a more effective method of early detection of small tumours than the traditional methods of clinical examination or self-examination (IARC, 2002b). With regular mammography, the average tumour size on detection is less than 1.5 cm, compared with 3.5 cm for occasional clinical examination, or 2 cm for regular clinical examination. Detecting a tumour when it is smaller than 1 cm gives a woman a 90% chance of survival (Louwman et al., 2008). Also see Consequences for individual and society.

The EPGBC calls for every woman in Europe to have access to the same first-class early detection, diagnosis, treatment and aftercare, irrespective of where she lives, her social status and her level of education. They establish requirements for mammography screening, treatment and the setting up of breast units according to European guidelines. The EPGBC also state that women between the ages of 50 and 69 must have the right to attend high-quality mammography screening at two-year intervals in dedicated and certified centres paid for by health insurance schemes.

In the 1990s mass screening by mammography was introduced as part of organized programs. Population-based screening ensures that all eligible women are invited to use the service. These programs substantially improved the awareness of the disease and the access to optimal treatment for the population at large. The declining mortality rates in many European countries are most likely connected to this development. The status of mammography screening in the EU and an evaluation of its impact are reviewed in a recent report on cancer control in the community (Coleman et al., 2008).

Some of the sub-clinical tumours detected by screening would take too long to become a threat. Treating all sub-clinical tumours the same as invasive ones may result in some over-treatment. This is an adverse effect of mass screening that health providers must be made aware of. There are ongoing clinical trials to develop less invasive and disabling treatments for sub-clinical cancers including in situ tumours. These may eventually help to clear concerns about over-treatment, as in the case of cancers of the cervix, colon and rectum.

Treatment options and survival rates depend on stage

Treatment of breast cancer involves surgical removal of the tumour followed by a combination of radiotherapy, chemotherapy, hormonal therapy, or immunomodulation, depending on the stage of the disease and other prognostic factors.

Tumours detected at an early stage (I or II) may opt for breast-conserving surgery combined with radiotherapy. More advanced cases require mastectomy and radiotherapy to control local recurrence. Most cases, unless unsuitable due to other clinical conditions, also receive systemic adjuvant treatment with chemotherapy and/or hormonal therapy. Also see Definition and scope.

Improved treatment is reflected in improved survival rates. See Survival of female breast cancer patients diagnosed in 1990-1994 and in 1995-1999.

Recent reviews by the EBCTCG have shown that over a few decades treatment for breast cancer has become more and more effective, in particular by its combination with the early detection of tumours. They have also shown that all of the treatment options widely available in Europe contribute to the long-term improvement in the disease prognosis (Clarke et al., 2005, EBCTCG, 2005).

Cases presenting at an advanced stage (IIIb and IV) receive palliative care aiming at reducing pain and suffering.