Du dépistage de masse au dépistage stratifié selon le risque

Historically, breast screening has exclusively been based only on the age of women to begin systematic mammography. In France, breast density is a key factor to add breast ultrasonography to mammography. Emerging technique such as digital breast tomosynthesis with synthetic mammography would allow both to optimize the number of detected breast cancer and to decrease the number of false positives and radiation dose. Except the group of very high-risk women (genetic mutation) who are screened with breast MR imaging, no precise strategy is validated in lower risk women with different lower risk factors such as family history of breast cancer, nulliparity, alcoholic impregnation… Thus, new strategies are in evaluation combining these factors in prediction models for a more personalized screening in Europe (« My PEBS » study) and United States (WISDOM study) to optimize the diagnostic strategy.