[CBO guideline 'Breast cancer: screening and diagnosis']

New developments in the diagnostic procedures for women with an increased risk for, or symptoms related to breast cancer led to development of new guidelines by a working group under the auspices of the Dutch Institute for Health Care Improvement, the Organisation of Comprehensive Cancer Centres and the National Breast Group of the Netherlands. Based on the best available evidence this working group formulated recommendations on the following topics: indications for screening within the population screening programme, screening outside the population screening programme, the diagnostic procedures of symptomatic and asymptomatic lesions in the breast and the organisation of the diagnostic work-up of patients with breast symptoms. The most important recommendations in the guidelines are: individual screening is recommended to certain groups of women who do not participate in the population screening programme, based on their risk profiles; available evidence does not support the extension of the population screening programme to women 40-49 years of age; diagnosis and treatment have to take place in a structured context, the so-called breast team; to guarantee optimal diagnostic procedures a multidisciplinary clinic is mandatory; the diagnostic work-up of breast abnormalities is based on the triple assessment: physical examination, imaging by mammography and/or ultrasound and needle biopsy. For quality-controlled implementation of this guideline, uniform prospective registration of patients, diagnosis and treatment related data is an important condition.