Prof. Michael Fuchsjäger  |  President, European Society of Breast Imaging (EUSOBI)

We've come a long way.

Twenty years ago, screening for breast cancer meant one thing: a single flat X-ray, the same test for every woman.

Today there are so many more ways to look. The newest machines photograph the breast from many angles, so a radiologist can move through the images like turning the pages of a book. Where dense tissue defeats an X-ray, ultrasound can find what it misses. For women at the highest risk, MRI can catch a cancer while it is still tiny. We find more cancers now, and we find them earlier.

The machines keep improving, too. Less radiation for the same clear picture – MRI scans in a fraction of the time they once took. And we're now matching the test to the woman.

Dense tissue shows why that matters. It works against us twice over: it hides cancers on a mammogram, and it raises the risk of getting one. So in Austria, my home country, ultrasound is not merely offered to women with the densest breasts. It is required.

At the other end of the scale, a woman at low risk might safely wait three years between mammograms, as some now do in the United Kingdom. A woman at high risk – a flawed BRCA gene, a strong family history, a past ovarian cancer – might have a mammogram, an MRI, and an ultrasound every year.

Large trials have shown that inviting women to regular mammograms cuts deaths from breast cancer by about a fifth. But a programme only saves lives if women actually attend. And across Europe, too many do not.

In both Austria and Germany, barely half of those invited actually come in for testing. And the figure is drifting down, not up.

Why do they stay away?

For some it is simple procrastination. For others, doubt. Some don't see the point at all. And some fear that the radiation might cause the very cancer we are looking for.

It doesn't. A mammogram delivers about as much radiation as you absorb naturally, from the ground and the sky, over roughly seven weeks of ordinary life – or one long plane flight. The good it does dwarfs that.

But saying so once is not enough. And explaining it, again and again, is something we in medicine have not always done well.

Launching a programme is the easy part. A government announces it, cuts the ribbon, ticks the box. The real work starts the next day and never stops.

Europe makes it harder. The continent, roughly the size of the United States, is divided into dozens of countries, each running screening its own way.

In parts of Scandinavia, a woman goes to one of a few large centres – perhaps one for every 150,000 people – has two quick images taken, and leaves. Austria built screening into hundreds of local clinics instead, so nobody travels far. Both are sensible. But neither has solved the real puzzle: how to make women want to come.

Perhaps artificial intelligence will help. A decade ago we were told it would replace radiologists within five years. It is 2026, and we are still here.

The attraction is practical. Every screening mammogram is meant to be read by two radiologists, and there are not enough radiologists to go around. AI could become that second pair of eyes; in trials, it has matched human readers. Or AI could set aside the plainly normal images, so doctors spend their time on the ones that worry them.

Money is the other constraint. Ultrasound and MRI find cancers a mammogram cannot – but ultrasound takes time and a skilled pair of hands, and an MRI scanner is expensive to buy and to run. The evidence arrives long before the budgets do.

This is where a medical society like ours earns its keep. EUSOBI is now the largest breast-imaging society in the world, with experts from every country in Europe. Each year we weigh the newest evidence and turn it into clear guidance.

Those recommendations are cited hundreds of times over. Tens of thousands of radiologists read them and carry them home. National bodies ask us for them, so they can take them to their own governments.

The science is ready. The tools are the finest we have ever had. What remains is the human task – explaining all of it clearly enough so that no woman who could be helped is left standing outside the door.