Starting at age 40, a yearly mammogram is recommended by the National Comprehensive Cancer Network, the American College of Obstetrics and Gynecology, and Cleveland Clinic's Breast Cancer Screening Task Force. 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) every 1-3 years for women aged 20-39, and every year for women 40 and over.
Self-breast awareness - women should know how their breasts normally look and feel and report any breast change promptly to their health care provider. Periodic, consistent breast self-exam (BSE) may help with breast self-awareness.
In November 2009, the US Preventive Services Task Force (USPSTF) recommended that most women can wait until age 50 to get their first mammogram. It 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, the USPSTF stated that the decision whether to start a screening mammogram 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.
In November 2015, the American Cancer Society (ACS) updated its recommendations for breast cancer screening in women of average risk. The ACS recommends that women with an average risk of breast cancer undergo annual screening mammograms between the ages of 45 and 54. Women 55 years and older should transition to mammograms every other year, or have the opportunity to continue screening annually. Women should have the opportunity to begin annual screening between the ages of 40 and 44. Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or more. The ACS no longer recommends clinical breast examination for women at any age.
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. 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 is diagnosed with invasive breast cancer in her 40s. Most 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 20% and 40% in women between the ages of 50 and 69. The drop in breast cancer death rate because of mammograms is between 20 and 30% for women between the ages of 39 and 49.
For some women who have mammograms regularly, there will be some "false positive” results. This means that the mammogram will show an area that needs follow-up, either with more imaging, or even a biopsy, until it is proven to be benign (not cancer). 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 the death rate from cancer.
Cleveland Clinic's approach:
The different viewpoints from various national organizations are 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. We 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.
Oeffinger KC, Fontham ETH, Etzioni R, et al. Breast Cancer Screening for Women at Average Risk
2015 Guideline Update From the American Cancer Society. JAMA. 2015;314(15):1599-1614.
United States Preventive Services Task Force.
Breast Cancer Screening Draft Recommendations
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