Overview
- The lifetime risk (to age 85) of a woman developing breast cancer in 1940 was 5 percent or 1 in 20; the risk is now 12.6 percent or 1 in 8. In women 40 to 49 years of age, there is a 1 in 66 risk of developing breast cancer compared with a 1 in 40 risk among women in the 50 to 59 year age group.
- Randomized, controlled trials have demonstrated reduced mortality rates (20 percent to 40 percent) from breast cancer among women invited to undergo screening mammography compared with control groups.
- Although statistically significant benefits/reductions in breast cancer mortality are delayed 10 to 15 years among women 40 to 49 years of age at the time of screening, several of the screening trials have reported a benefit (23 percent to 44 percent) from screening women 40 to 49 years of age.
- The benefit of mammography is related to early detection. Regardless of the histological grade of a tumor, a greater than 90 percent 10 year survival rate has been reported in 40 to 74 year old women diagnosed with tumors that are 10 mm or smaller in size.
- The effectiveness of any screening program will depend on screening frequency, compliance with screening recommendations and the quality of the screening test.
- In establishing screening frequencies, breast cancer growth rates need to be considered. The sojourn time (average time for mammographically detectable, pre-clinical cancers to become clinically apparent) for all breast cancer types is shorter for pre-menopausal women compared with post-menopausal women, supporting annual screening in 40 to 49 year old women: 1.8 years in 40 to 49 year old women and 3.5 years in women 50 years of age or older.
Recommendations for breast cancer screening
- Monthly breast self examination starting at age 20
- Breast physical examination by a health care provider every three years starting at age 20; annual clinical breast physical exam starting at age 40
- Baseline mammogram at age 35
- Annual screening mammography starting at age 40
- Women in high risk categories (first degree relative with breast cancer; personal history of breast cancer; prior biopsy with atypical ductal hyperplasia or lobular carcinoma in situ) may want to consider starting screening at age 30.
Committee members
Joseph Crowe, MD, Director, Cleveland Clinic Breast Center
James Gutierrez, MD, General Internal Medicine, Cleveland Clinic Westlake
Holly Thacker, MD, Department of General Internal Medicine
Reference material:
- Report of the U.S. Preventive Services Task Force. Guide to Clinical Services. Baltimore, MD: Williams & Wilkins, 1996.
- Breast Cancer Screening for Women Ages 40-49. NIH Consensus Statement 1997; January 21-23; 15(1): In-press.
- American Cancer Society, Workshop on Guidelines for Breast Cancer Detection, Chicago, March 7-9, 1997. [Online] Available http://www.cancer.org/mammog.html, October 7, 1997.
- Salzmann P, Kerlikowske K, Phillips K. Cost-Effectiveness of Extending Screening Mammography Guidelines to Include Women 40 to 49 Years of Age. Annals of Internal Medicine 1997; 127: 955-965.
- Ransohoff DF, Harris RP. Lessons from the Mammography Screening Controversy: Can We Improve the Debate? Annals of Internal Medicine 1997; 127: 1029-1034.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 6/6/2006...#5642
