Screening for Breast Cancer
The purpose of screening is early diagnosis and treatment. Screening tests are administered to people without current symptoms, but who may be at average or high risk for certain diseases or conditions.
Several professional organizations have published sometimes differing guidelines for breast cancer screening. Though this may seem confusing, the ultimate goal is to encourage individuals to discuss the risks, harms, and benefits of different breast cancer screening tests with their doctor.
The most current guidelines below are from the United States Preventive Services Task Force, the American Cancer Society, and the American Congress of Obstetricians and Gynecologists.
Screening Guidelines for Average Risk
Clinical Breast Exam
United States Preventive Services Task Force
Age 40-49: Shared decision with doctor to have a mammogram every 2 years until age 50.
Age 50 and older: Every 2 years until age 74.
Age 75 and older: No recommendation given.
|No recommendation given.
||Against teaching women how to do breast self-exam.
American Cancer Society
Age 40-44: Women can start screening if that is their choice. Start talking about screening tests with your doctor.
Age 45-54: Every year.
Age 55 and older: Start transitioning to every 2 years, and continue as long as overall health is good and life expectancy is 10 years or more. A mammogram every year can be done for women who choose to do so.
American Congress of Obstetricians and Gynecologists
Age 40 and older: Every year.
Age 20-39: Every 1-3 years.
Age 40 and older: Every year.
|Encourage breast self-awareness.
Information given on self-exam for women who choose to do so.
Breast self-awareness is very important at any stage of life. Be aware of any changes, such as new or disappearing lumps, clear or bloody nipple discharge, dimpling or thickening of the skin, pain, or a feeling of fullness in the underarm area. Not all breast cancers cause symptoms and not all breast changes are caused by cancer, but it is important to discuss these with your doctor so they can determine if further testing is needed.
Screening Guidelines for High Risk
If you are in a high-risk group for developing breast cancer, you and your doctor will schedule more frequent screening tests, which will start at an earlier age.
The American Cancer Society recommends a yearly mammogram with an MRI scan starting at age 30 years for women with:
- A high risk assessment score
- One of the BRCA genes—if tested
- First-degree relative with one of the BRCA genes—if not tested
- A history of high-dose radiation to the chest from ages 10-30 years
- A personal history or first-degree relative with certain syndromes that increase risk of breast cancer, such as Li-Fraumeni, Cowden, or Bannayan-Riley-Ruvalcaba
The United States Preventive Services Task Force recommends:
- Monthly breast self-exams for women aged 18-21 years
- For women aged 25-35 years:
- Clinical breast exam every 6-12 months
- Yearly mammogram
The American Congress of Obstetricians and Gynecologists recommends that high-risk women consider doing regular breast self-exams.
There are 3 main tests to screen women for breast cancer. Not all organizations recommend these methods, but you may choose to do them after you discuss the risks, harms, and benefits with your doctor. These include:
—Overall, there is a a lack of evidence that breast self-exams are effective in reducing the risk of death from cancer. A self-exam can cause unnecessary anxiety. Before you do breast self-exams, talk to your doctor about proper technique.
Clinical breast exam—The doctor will carefully feel your breasts and under your arms to check for lumps or other unusual changes.
—An imaging test that takes an x-ray of the breast, which may detect tumors that are too small to be felt. The accuracy of a mammogram to detect cancer depends on several factors including the density of breast tissue. Although a mammogram is the most sensitive test currently used to evaluate the breast, it will miss 10%-15% of breast cancers. Mammograms can also indicate a tumors when there is no tumor almost 1/3 of the time. The possibility for this false-positive is one of the reasons some organizations changed screening guidelines.
Other Imaging Tests
may be used to screen high-risk women.
American Cancer Society recommendations for early breast cancer detection in women without breast symptoms. American Cancer Society website. Available at: http://www.cancer.org/cancer/breastcancer/moreinformation/breastcancerearlydetection/breast-cancer-early-detection-acs-recs. Updated October 20, 2015. Accessed November 3, 2015.
American Congress of Obstetricians and Gynecologists (ACOG). Breast cancer screening. National Guideline Clearinghouse website. Available at: http://www.guideline.gov/content.aspx?id=34275. Updated August 2011. Accessed November 3, 2015.
Breast cancer: Screening. United States Preventive Services Task Force website. Available at: http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/breast-cancer-screening?ds=1&s=breast cancer. Updated November 2009. Accessed November 3, 2015.
Breast cancer screening. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 18, 2015. Accessed November 3, 2015.
10/23/2009 DynaMed Systematic Literature Surveillance:
http://www.ebscohost.com/dynamed. Nothacker M, Duda V, Hahn M, et al. Early detection of breast cancer: benefits and risks of supplemental breast ultrasound in asymptomatic women with mammographically dense breast tissue. A systematic review.
1/19/2010 DynaMed's Systematic Literature Surveillance:
http://www.ebscohost.com/dynamed. Lee CH, Dershaw DD, Kopans D, et al. Breast cancer screening with imaging: recommendations from the Society of Breast Imaging and the ACR on the use of mammography, breast MRI, breast ultrasound, and other technologies for the detection of clinically occult breast cancer.
J Am Coll Radiol.
8/7/2011 DynaMed's Systematic Literature Surveillance:
http://www.ebscohost.com/dynamed. Gotzsche PC, Jorgensen KJ. Screening for breast cancer with mammography. Cochrane Database Syst Rev. 2013;6:CD001877.