Breast Cancer Screening Guidelines for Women

International American
U.S. Preventive American College of
American Cancer Agency for American College American College of Academy of
Services Task Obstetricians and
Society3 Research on of Radiology8,9 Physicians10 Family
Force1,2 Gynecologists4,5,6
Cancer7 Physicians11
Women The decision to start Women aged 40 to 44 After counseling and if an There is limited Screening with Clinicians should discuss The decision to start
aged 40 to screening with years should have the individual desires screening, evidence that screening mammography is whether to screen for screening with
49 years mammography in choice to start breast mammography may be with mammography recommended once a breast cancer with mammography
with women prior to age 50 cancer screening once a offered once a year or once reduces breast cancer year. mammography before should be an
average risk years should be an year with every two years and clinical mortality in women 40- age 50 years. Discussion individual one.
individual one. Women mammography if they breast exams may be 49 years of age. should include the Women who place a
who place a higher value wish to do so. The risks offered once a year. potential benefits and higher value on the
on the potential benefit of screening as well as Decisions between harms and a woman’s potential benefit than
than the potential harms the potential benefits screening with preferences. The the potential harms
may choose to begin should be considered. mammography once a year potential harms may choose to begin
screening once every Women aged 45 to 49 or once every two years outweigh the benefits in screening.
two years between the years should be should be made through most women aged 40 to
ages of 40 and 49 years. screened with shared decision-making 49 years.
mammography annually. after appropriate
counseling.
Women Screening with Women aged 50 to 54 Screening with There is sufficient Screening with Clinicians should offer Screening with
aged 50 to mammography once years should be mammography is evidence that screening mammography is screening with mammography is
74 years every two years is screened with recommended once a year with mammography recommended once a mammography once recommended once
with recommended. mammography annually. or once every two years. reduces breast-cancer year. every two years. every two years.
average risk For women aged 55 Decisions between mortality to an extent
The evidence is In average-risk women Current evidence is
years and older, screening with that its benefits
insufficient to assess the of all ages, clinicians insufficient to assess
screening with mammography once a year substantially outweigh
additional benefits and should not use clinical the benefits and
mammography is or once every two years the risk of radiation-
harms of clinical breast breast examination to harms of clinical
recommended once should be made through induced cancer from
examination. screen for breast cancer. breast exams.
every two years or once shared decision-making mammography.
a year. Women aged 55 after appropriate
There is inadequate
years and older should counseling.
evidence that clinical
transition to biennial
Clinical breast exams may breast examination
screening or have the
be offered annually. reduces breast cancer
opportunity to continue
mortality. There is
screening annually. Clinical breast exams should
sufficient evidence that
be offered in the context of
Among average risk clinical breast
a shared, informed decision-
women, clinical breast examination shifts the
making approach that
examination to screen stage distribution of
recognizes the uncertainty
for breast cancer is not tumors detected
of additional benefits and
recommended. toward a lower stage.
harms of clinical breast
examination beyond
screening mammography.
 International American
U.S. Preventive American College of
American Cancer Agency for American College American College of Academy of
Services Task Obstetricians and
Society3 Research on of Radiology8,9 Physicians10 Family
Force1,2 Gynecologists4,5,6
Cancer7 Physicians11
Women Current evidence is Women should continue The decision to stop Not addressed. The age to stop In average-risk women Current evidence is
aged 75 insufficient to assess the screening with screening should be based screening with aged 75 years or older insufficient to assess
years or balance of benefits and mammography as long on a shared decision-making mammography or in women with a life the balance of
older with harms of screening as their overall health is process. The decision- should be based on expectancy of 10 years benefits and harms of
average risk mammography in good and they have a making process should each woman’s health or less, clinicians should screening with
women aged 75 years or life expectancy of 10 include a discussion of the status rather than an discontinue screening mammography.
older. years or more. woman’s health status and age-based for breast cancer.
longevity. determination.
Women Current evidence is Evidence is insufficient Other than screening with There is inadequate In addition to There is insufficient Current evidence is
with dense insufficient to assess the to recommend for or mammography, the evidence that mammography, evidence on benefits insufficient to assess
breasts balance of benefits and against yearly MRI organization does not ultrasonography as an contrast-enhanced and harms of screening the balance of
harms of adjunctive screening. recommend routine use of adjunct to breast MRI is also strategies in women benefits and harms of
screening for breast alternative or additional mammography reduces recommended. After who have dense breasts. adjunctive screening
cancer using breast tests. Health care providers breast cancer mortality. weighing benefits for breast cancer
ultrasonography, should comply with state There is limited and risks, ultrasound using breast
magnetic resonance laws that may require evidence that can be considered for ultrasonography,
imaging (MRI), digital disclosure to women of ultrasonography as an those who cannot MRI, DBT, or other
breast tomosynthesis their breast density as adjunct to undergo MRI. methods.
(DBT), or other methods recorded in a mammogram mammography
in women identified to report. increases the breast
have dense breasts on cancer detection rate.
an otherwise negative There is sufficient
screening mammogram. evidence that
ultrasonography as an
adjunct to
mammography
increases the
proportion of false
positive screening
outcomes.

Women at high risk

Some organizations release different breast cancer screening guidelines for women who are considered to be at high risk of developing breast cancer. Different
screening guidelines may be suggested for women who have risk factors such as a BRCA1 or BRCA2 mutation, who are an untested family member of someone
who has a BRCA1 or BRCA2 mutation, who have a history of mantle or chest radiation which occurred before age 30 years, or who have a lifetime breast cancer
risk of 20% or greater based on their family history. Additional information on screening guidelines for women at high risk can be found in the references.1,3,6,7,9
References

Siu AL; U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Annals of Internal
1

Medicine 2016;164(4):279–296.
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U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine
2009:151(10):716–726.
3
Oeffinger 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.
4
Committee on Gynecologic Practice. Committee opinion no. 625: Management of women with dense breasts diagnosed by mammography. Obstetrics and
Gynecology 2015;125(3):750–751.
5
Committee on Practice Bulletins–Gynecology. Practice bulletin number 179: Breast cancer risk assessment and screening in average-risk women. Obstetrics and
Gynecology 2017;130(1):e1–e16.
6
Committee on Practice Bulletins–Gynecology, Committee on Genetics, Society of Gynecologic Oncology. Practice bulletin No. 182: Hereditary breast and ovarian
cancer syndrome. Obstetrics and Gynecology 2017;130(3):e110–e126.
7
Lauby-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.
8
Monticciolo DL, Newell MS, Hendrick RE, Helvie MA, Moy L, Monsees B, Kopans DB, Eby PR, Sickles EA. Breast cancer screening for average-risk women:
Recommendations from the ACR commission on breast imaging. Journal of the American College of Radiology 2017;14(9):1137–1143.
9
Monticciolo DL, Newell MS, Moy, L, Niell B, Monsees B, Sickles EA. Breast cancer screening in women at higher-than-average risk: Recommendations from the
ACR. Journal of the American College of Radiology 2018;15(3 Pt A):408–414.

Qaseem A, Lin JS, Reem AM, Horwitch CA, Wilt TJ. Screening for breast cancer in average-risk women: Statement from the American College of Physicians.
10

Annals of Internal Medicine 2019;170(8):547–560.

American Academy of Family Physicians. Summary of recommendations for clinical preventive services. 2016. Available from:
11

http://www.aafp.org/dam/AAFP/documents/patient_care/clinical_recommendations/cps-recommendations. [PDF-276KB]

Document reviewed September 22, 2020