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The Cleveland Clinic Breast Cancer Screening Guideline

Starting at age 40, a yearly mammogram is recommended by the American Cancer Society, the American College of Obstetrics and Gynecology, the National Comprehensive Cancer Network, and Cleveland Clinic's Breast Cancer Screening Task Force. More specifically, the American Cancer Society guidelines state:

  • Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health
  • A breast exam by a trained provider (also called a clinical breast exam) about every 3 years for women aged 20-39, and every year for women 40 and over.
  • Women should know how their breasts normally look and feel and report any breast change promptly to their health care provider. Breast self-exam is an option for women starting in their 20s.

In November 2009, the US Preventive Services Task Force (USPSTF) recommended that most women can wait until age 50 to get their first mammogram. They also suggested that women get their mammograms every other year instead of every year, and that physicians should not teach their patients about breast self examination. For women between the ages of 40-49, they stated that the decision whether to start a screening mammogram every 2 years should be individualized, taking into account a woman’s preferences after discussing the possible benefits and harms with her doctor. Various professional and advocacy groups have reacted differently to these suggestions, and as a result, women are unsure about the optimal screening for breast cancer.

Some women – because of their family history, a genetic tendency, or certain other factors – can be screened with MRI in addition to mammograms. The number of women who fall into this category is small: less than 2% of all the women in the US. Talk with your doctor about your history and whether you should have additional tests at an earlier age.

To try to understand the controversies better, let's review the facts:

What the studies show:

The lifetime risk of a woman developing breast cancer is one in 8.Breast cancer occurs less often in women under age 50. However, approximately 1 in 69 women are diagnosed with invasive breast cancer in their 40s. Many of these women do not have a family history of breast cancer.

Screening mammogram has consistently shown to reduce death rates from breast cancer in all age groups. The reduced death rate ranges between 14-32% in women between the ages of 50-69. The drop in breast cancer death rate because of mammograms is about 15% for women between the ages of 39-49.

For some women who do mammograms regularly, there will be some "false positive” results. This means that the mammogram will show an area that needs followup, either with more imaging, or even an unnecessary biopsy, until it is proven to be benign. The rates of these "false positive” findings on the mammogram tend to be higher in younger women, but are infrequent overall. Most women accept the temporary anxiety associated with false positive findings knowing that screening mammograms can detect cancer earlier and reduce mortality from breast cancer.

What the studies are unsure of:

It is not clear whether breast self examinations done by patients really helps with decreasing death rate from cancer.

Beyond age 70, the exact risks versus benefits of mammograms are less clear.

Cleveland Clinic's approach:

The different viewpoints from various national organizations were confusing for both patients and physicians. In 2010, Cleveland Clinic published some recommendations from a task force, which included physicians from a variety of subspecialties, including oncology, primary care, radiology, and breast surgery. They recommended:

  • Starting yearly screening with mammography at age 40, and to continue as long as a woman’s life expectancy is at least 10 years (meaning they are otherwise in a good state of health).
  • Screening every other year is an option for older postmenopausal women. Patients should discuss the pros and cons of this approach with their doctor.
  • Careful examination of the breasts remains an important part of the general physical examination.
  • Women should continue to be familiar with their breasts, and report any changes to their physicians.
References:

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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: 12/31/2012...#5642