To summarize, all of the following will be considered when making decisions about screening programs or guidelines. Are these factors considered in the ongoing discussions about mammography guidelines?

Patient/Community/Population Considerations

• Acceptability/desirability by patient and community
• The historical precedent for screening
• The sufficient burden of disease

Epidemiological/Medical Considerations

• Different populations have a distinct and different distributions of disease
• The natural history of disease supports early detection
• Availability of ‘adequate’ screening tests
• Availability of and compliance with ‘effective’ treatment and follow up
• Acceptability by the provider and health care system

Resource Considerations

• Will of the political and healthcare system
• Availability of resources - funds, services, transportation,…
• Cost-effectiveness of screening