Here’s a faithful English translation with medical tone, clear flow, and zero “marketing gloss”:

Obviously, with imaging combined with clinical examination and the newer therapies we have against breast cancer, we have achieved a great deal.
Nevertheless, the importance of performing mammographic screening on an annual basis in women over the age of 40 has not been proven. Where we do have substantial evidence is for women aged 50 to 69. Unfortunately, malignancy is not a disease of the young but, regrettably, of older age.

Despite what is happening around us, the standard of living has improved dramatically since the 1940s. Women used to pass away without the cause of their illness ever being diagnosed. We talk more and hear even more about breast cancer because, quite simply, we now all have access to diagnostic centers, and on the other hand we live longer (average life expectancy has increased from around 55–60 years, as it may have been in the 1940s, to over 80 years today). Clearly, through prevention we are doing much better at younger ages, but unfortunately malignancy and aging go hand in hand.

It is a fact that we diagnose more early-stage disease compared with advanced disease, and this has enormous importance for survival. It is enough to consider that 5-year survival in patients with stage I disease is over 92%, whereas in stage II/III (that is, locally or regionally advanced disease in the breast or axilla with a large oncologic burden due to tumor size), studies show that 5-year survival ranges from 50% to 82%.

But what evidence do we actually have in our hands regarding prevention? From what age should a woman begin screening, and what should that screening be? If a woman starts having mammograms earlier, should she feel safer? The more, the better? The tool that has proven benefit for prevention is this “dinosaur” we call the mammogram.

So far, seven studies have been conducted on breast cancer prevention in relation to mammography. The first was carried out in the 1960s by insurance companies in New York. Others followed with larger populations but less robust study design (the Swedish studies), and others involved more than 190,000 women across multiple diagnostic centers with follow-up exceeding 17 years (the AGE TRIAL), but within a system that exists only in one country (the United Kingdom, with randomization that includes a mammogram every three years).

These studies highlight that we are certainly doing something wrong. The most recent study, which divided women into two large groups (comparison of annual mammography starting at age 40—control group—versus mammography every three years starting at age 50—target group), showed no long-term benefit if a woman started screening from the age of 40. Instead, yet again, I would add, it observed a phenomenon called overtreatment.

What does this mean? Does it mean what we are doing is wrong? That women should not start screening at 40? Absolutely not. It simply means that, at times, we may subject our patients to unnecessary tests and surgeries that burden an already strained healthcare system without changing overall survival. This study showed that the phenomenon of overtreatment is due to the detection of a lesion called “DCIS.” A lesion we call pre-cancerous, yet without having fully understood this clinical entity and what drives it to become invasive and therefore more aggressive.

Greece has no national guidelines for breast cancer. And it certainly does not have an organized screening system from which we could draw conclusions, as our colleagues in the United Kingdom and so many other European countries do. Nevertheless, we tend to follow, in part, the guidelines of the European School of Oncology. We recommend that women begin their screening from the age of 40 (level of evidence IIb), although according to these guidelines the greatest benefit lies in performing mammography from the age of 50 (level of evidence Ia) and above.

Clearly, I am not implying that a woman should start screening only at 50. Not everything in life is strictly cost–benefit. At the same time, we live in a country where the healthcare system—rightly or wrongly—places its trust in the individual physician rather than in structured authorities. It will rarely refuse any test if the physician requests it. “Tailoring,” that is, INDIVIDUALIZATION, is particularly important. This is what distinguishes the breast specialist from a colleague who deals with breast surgical oncology only occasionally. That is why my advice is ALWAYS to seek a physician whose curriculum clearly shows that the breast is their primary field. This doctor will guide you on when you should have your first imaging examination and where. However, questions and observations will continue to arise. For example: how can we ultimately create prevention mechanisms for something about which, in practical terms, we still know very little (cancer)? Every study like the ones I mentioned above requires a long follow-up period. When the results finally come out, they reflect a healthcare system from 20 years earlier—with the imaging methods and therapies of that time—and do not necessarily mirror the needs of today’s era and today’s healthcare system.

We need to introduce different primary endpoints in studies—endpoints that matter to the average woman being screened. Pain, quality of life, recall rates, distant metastases—these could be included and could replace the identification of new breast cancer cases or breast cancer–specific mortality that we have used so far.

In addition, it is evident that new technologies are needed for early diagnosis (e.g., artificial intelligence algorithms). Research in imaging should begin to progress at the same pace as research in pharmacological treatment.