Cáncer de mama en la era genómica: ¿sirve de algo la detección precoz?

Objectives : to carry out a critical evaluation about the current role of early detection and the contribution of radiological methods to it. Methods : bibliographic review that aims to address the following aspects: a) Influence of the Halsted and Fisher paradigms on the importance and strategy of early detection; b) Contribution and limitations of the various radiological methods; c) Impact of screening mammography in reducing breast cancer mortality; c) Importance of a personalized radiological strategy for early detection. Results : 68% of the tumors detected in screening show a low risk gene profile (54% “ultra low”), which reaches 81% (63% “ultra low”) in the prevalent round. The reduction in the mortality rate among women who participate regularly in screening programs ranges between 12% and 65%, depending on the age groups that participate and the methodology applied . The average sensitivity of mammography is 79.9%, although it is reduced to 50% in "dense" mammography patterns. Especially in "dense" type breasts, the addition of breast ultrasound and magnetic resonance imaging allows an increase in detection rates of up to 4.4 / 1,000 and 28.6 / 1,000, respectively, although at the cost of increasing the rates of False Positive. Conclusions : given any of the paradigms considered, early radiological detection offers clear advantages in terms of survival and mortality. In order to avoid false expectations, it is very important for the patient to assume that early detection does not necessarily imply a good prognosis. The reduction in mortality rates is based on improved early detection (mainly thanks to personalized strategies, as well as advances in predictive / prognostic evaluation and therapeutic improvements.