Risk factors as an indicator for breast cancer screening in asymptomatic patients.

A review of breast carcinoma risk factors has established that age and sex are dominant variables. Additional epidemiological factors include family history, past medical history, menstrual status, age at birth of first child, demographic factors and reproductive history, which are of established importance as major or minor risk determinants for breast cancer. Taking into account the various epidemiological correlations and the multifactorial aetiology of this type of carcinoma, there is only a small probability that the identification of known risk factors will enable conclusive identification or prevention of the disease. Nevertheless the recognition of known risk factors may enhance screening efforts through surveillance, more selective biopsies and interval xeromammography. Total ductoglandular mastectomy may possibly be considered a beneficial approach to the management of the high-risk patient in whom preinvasive disease is detected. The identification of the high-risk patient is of paramount importance for prophylaxis. Prospective clinical trials using diagnostic approaches may include the study of genetic markers, hormones and steroid metabolites, mammographic parenchymal patterns and the analysis of genetic pedigree or other undetermined risk markers. While screening and detection programmes for breast carcinoma are not cost-effective, these intensive surveillance procedures do allow the early identification of high-risk individuals with the disease. The formulation of screening programmes which incorporate major and minor risk determinants may enhance the effectiveness of efforts to achieve diagnosis at a prognostically favourable stage of disease. Established diagnoses of stage 0 or stage I disease will translate as direct benefits to survival and reductions in economic morbidity.