ern cancer progression, no one can predict with certainty which patients will be “cancer survivors” after treatment.

To date, no way to prevent breast cancer has been discovered and experience has shown that treatments are most effective when a cancer is detected early, while still small and contained and before it has spread to other tissues. Those two facts suggest that, at the present time, improving early detection and diagnosis is the most effective way to continue reducing the toll from breast cancer.

Several years ago an Institute of Medicine (IOM) and National Research Council (NRC) committee examined the array of promising detection and diagnostic technologies then in various stages of development, and concluded that mammography, while far from perfect, was still the best choice for screening the general population to detect breast cancer at early and treatable stages. Their findings and recommendations were published in 2001 in Mammography and Beyond: Developing Technologies for Early Detection of Breast Cancer.

For a variety of reasons, many women do not undergo regular screening. These reasons include limited availability of screening in some areas, inadequate insurance coverage, and misunderstanding of the value of screening. Also, some women are so afraid of breast cancer they choose not to be screened. Others find the procedure painful. The fact that mammography does not work equally well for all women, especially those with dense breast tissue, is a further complication.

In addition, the potential for false-positive and false-negative results remains high. Studies suggest that, due to a lack of sensitivity leading to false-negative findings, mammography screening may miss as many as 1 in 6 tumors. At the other extreme, the risk of a false-positive result is about 1 in 10, meaning that about 1 in 10 suspicious findings on a screening mammogram are false alarms. About three-quarters of suspicious areas biopsied as a result of a mammogram turn out to be benign—though only after a woman has endured the fear that she has breast cancer and borne the costs and discomfort of additional medical procedures.

In 2002, the IOM and NRC named a second committee to examine which of the approaches identified in Mammography and Beyond held the greatest promise for improving early detection and diagnosis. In addition, this group was asked to both identify and recommend ways to overcome and/or circumvent barriers to the development, evaluation, and, finally, incorporation into clinical practice of those strategies with the greatest potential.

Charged with developing a rational and workable framework for the early detection and diagnosis of breast cancer, the committee was also given the broader, and in some ways more formidable, challenge of improving the

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