Breast Cancer Screening Guidelines for Women

Breast Cancer Screening Guidelines for Women

Women aged 40 to 49 with average risk

Women aged 50 to 74 with average risk

U.S. Preventive Services Task

Force1 2016

American Cancer American College

Society2

of Obstetricians

2015

and

Gynecologists3

2011

International Agency for Research on

Cancer4 2015

American College American College of Radiology5 of Physicians6 2010

American Academy of

Family Physicians7

2016

The decision to Women aged 40 to Screening with Insufficient

start screening 44 years should mammography and evidence to

mammography in have the choice to clinical breast

recommend for or

women prior to age start annual breast exams annually. against screening.

50 years should be cancer screening

an individual one. with mammograms

Women who place if they wish to do

a higher value on so. The risks of

the potential

screening as well

benefit than the as the potential

potential harms benefits should be

may choose to considered.

begin biennial

screening between Women aged 45 to

the ages of 40 and 49 years should

49 years.

get mammograms

every year.

Screening with mammography annually.

Discuss benefits The decision to

and harms with start screening

women in good mammography

health and order should be an

screening with

individual one.

mammography Women who place

every two years if a a higher value on

woman requests it. the potential

benefit than the

potential harms

may choose to

begin screening.

Biennial screening Women aged 50 to Screening with For women aged Screening with

mammography is 54 years should mammography and 50 to 69 years, mammography

recommended. get mammograms clinical breast

screening with

annually.

every year.

exam annually. mammography is

recommended.

Women aged 55

years and older

For women aged

should switch to

70 to 74 years,

mammograms

evidence suggests

every 2 years, or

that screening with

have the choice to

mammography

continue yearly

substantially

screening.

reduces the risk of

death from breast

cancer, but it is not

currently

recommended.

Physicians should encourage mammography screening every two years in average-risk women.

Biennial screening with mammography.

U.S. Preventive Services Task

Force1 2016

American Cancer American College

Society2

of Obstetricians

2015

and

Gynecologists3

2011

International Agency for Research on

Cancer4 2015

American College American College of Radiology5 of Physicians6

2010

American Academy of

Family Physicians7

2016

Women aged 75 or older with average risk

Current evidence is Screening should Women should, in

insufficient to

continue as long as consultation with

assess the balance a woman is in good their physicians,

of benefits and health and is

decide whether or

harms of screening expected to live 10 not to continue

mammography in more years or

mammographic

women aged 75 longer.

screening.

years or older.

Not addressed.

Screening with Screening is not mammography recommended. should stop when life expectancy is less than 5 to 7 years on the basis of age or comorbid conditions.

Current evidence is insufficient to assess the balance of benefits and harms of screening with mammography.

Women with Current evidence is There is not

dense breasts insufficient to

enough evidence

assess the balance to make a

of benefits and recommendation

harms of adjunctive for or against

screening for

yearly MRI

breast cancer

screening.

using breast

ultrasonography,

magnetic

resonance imaging

(MRI), digital

breast

tomosynthesis

(DBT), or other

methods in women

identified to have

dense breasts on

an otherwise

negative screening

mammogram.

Insufficient evidence to recommend for or against MRI screening.

Insufficient evidence to recommend for or against screening.

In addition to mammography, ultrasound can be considered.

Not addressed.

Current evidence is insufficient to assess the balance of benefits and harms of adjunctive screening for breast cancer using breast ultrasonography, MRI, DBT, or other methods.

Women at higher than average risk

U.S. Preventive Services Task

Force1 2016

Women with a parent, sibling, or child with breast cancer are at higher risk for breast cancer and thus may benefit more than average-risk women from beginning screening in their 40s.

American Cancer American College

Society2

of Obstetricians

2015

and

Gynecologists3

2011

International Agency for Research on

Cancer4 2015

American College American College of Radiology5 of Physicians6

2010

American Academy of

Family Physicians7

2016

Women who are at For women who Evidence suggests For BRCA1 or

Not addressed.

high risk for breast test positive for that screening

BRCA2 mutation

cancer based on BRCA1 or BRCA2 (mammography carriers, untested

certain factors

mutations or have and MRI) at an family members of

(such as having a a lifetime risk of earlier age may be BRCA1 or BRCA2

parent, sibling, or 20% or greater, beneficial.

mutation carriers,

child with a BRCA screening should

and women with a

1 or BRCA2 gene include twice-

lifetime risk of 20%

mutation) should yearly clinical

or greater (based

get an MRI and a breast exams,

on family history),

mammogram every annual

screening should

year.

mammography,

include annual

annual breast MRI,

mammography and

and breast self-

annual MRI starting

exams.

by age 30 years

but not before age

For women who

25 years.

received thoracic

irradiation between

For women with a

ages 10 and 30

history of chest

years, screening

irradiation between

should include

the ages of 10 and

annual

30 years, annual

mammography,

mammography and

annual MRI, and

annual MRI starting

screening clinical

8 years after

breast exams

treatment

every 6 to 12

(mammography not

months beginning

recommended

8 to 10 years after

before age 25).

radiation treatment

or at age 25 years.

Not addressed.

U.S. Preventive Services Task

Force1 2016

American Cancer American College

Society2

of Obstetricians

2015

and

Gynecologists3

2011

International Agency for Research on

Cancer4 2015

Additional Current evidence is Women should be Not addressed.

issues

insufficient to

familiar with the

relevant for all assess the benefits known benefits,

women

and harms of

limitations, and

digital breast

potential harms

tomosynthesis

associated with

(DBT) as a primary breast cancer

screening method screening. They

for breast cancer. should also be

familiar with how

their breasts

normally look and

feel and report any

changes to a

health care

provider right

away.

Not addressed.

American College American College of Radiology5 of Physicians6

2010

American Academy of

Family Physicians7

2016

Not addressed.

Annual mammography, MRI, tomosynthesis, or regular systematic breast self-exam are not recommended.

Recommends against clinicians teaching women breast self-exams. Current evidence is insufficient to assess the benefits and harms of clinical breast exams and DBT.

1Siu AL; U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine 2016;164(4):279?296.

2Oeffinger KC, Fontham ET, Etzioni R, Herzig A, Michaelson JS, Shih YC, Walter LC, Church TR, Flowers CR, LaMonte SJ, Wolf AM, DeSantis C, Lortet-Tieulent J, Andrews K, Manassaram-Baptiste D, Saslow D, Smith RA, Brawley OW, Wender R; American Cancer Society. Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society. JAMA 2015;314(15):1599?1614.

3American College of Obstetricians-Gynecologists. Practice bulletin no. 122: Breast cancer screening. Obstetrics and Gynecology 2011;118(2 Pt 1):372?382.

4Lauby-Secretan B, Loomis D, Straif K. Breast-cancer screening--viewpoint of the IARC Working Group. New England Journal of Medicine 2015;373(15):1478? 1479.

5Lee CH, Dershaw DD, Kopans D, Evans P, Monsees B, Monticciolo D, Brenner RJ, Bassett L, Berg W, Feig S, Hendrick E, Mendelson E, D'Orsi C, Sickles E, Burhenne LW. 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. Journal of the American College of Radiology 2010;7(1):18?27.

6Wilt TJ, Harris RP, Qaseem A; High Value Care Task Force of the American College of Physicians. Screening for cancer: advice for high-value care from the American College of Physicians. Annals of Internal Medicine 2015;162(10):718?725.

7American Academy of Family Physicians. Summary of recommendations for clinical preventive services. 2016. Available from: [PDF-574KB].

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