Mammography and breast cancer screening.

Dr. Pan and colleagues in this issue commented that there is a substantial policy favoring and emphasis on early detection and treatment of various kinds of cancers prevalent in developed countries. In Taiwan, the government not only provides Pap smears for cervical cancer screening, but has maintained a nationwide, free and biennial mammographic screening program since 2004. There was a significant 10-year delay from the time that Pap smear screening began to be widely used in Taiwan in 1995. Like most medical developments that have to go through routine channels of administrative review, the path to ultimate approval by the Taiwanese government can be challenging. The Pap smear procedure in Taiwan also faced many difficulties, given that Pap smear was likely first introduced in Taiwan as early as 1974. Although the benefits of Pap smear have been long established, more than 20 years were wasted in the elongated process for this procedure be accepted as a screening tool. The progress in cancer screening facilitated by the use of Pap smear has acted to reduce the substantial onset and spread of invasive cervical cancer in the majority of women. Since the Pap smear screening program was introduced, the incidence rate (IR) of invasive cervical cancer has dramatically decreased and continues to decline. Because there has been considerably more frequent and earlier detection of precancer cervical lesions, the IR of invasive cervical cancer has remained below the IR of pre-cancer cervical lesion since 1998; that IR remains persistently low in 2014. To date, the covering rate of 3-year Pap smear was up to 57% of women 30 years of age. This covering rate has helped to decrease the number of newly diagnosed cases of far-advanced cervical cancer, reduce the cost of medical care, and further significantly improved outcomes for patients and prolonged their lives. How significant is the mammographic screening program? It has been reported that the covering rate of the target population in Taiwan (between 45e69 years of age) was nearly one third in the most recent 2 years, contributing to a substantial increase in the number of cases of breast cancer that were detected. Therefore, the actual incidence of invasive breast cancer increased significantly. In 2011, the IR of breast