Screening for Breast Cancer

by Michael Jubinville, MPH

Screening is done to find a health problem early and treat it. Tests are usually given to people who do not have symptoms but who may be at high risk for the health problem.

Ask your doctor when you should be screened and how often. Screening guidelines differ and can be confusing. The goal is to have women to their doctor about these tests.

The chart below is from the United States Preventive Services Task Force (USPSTF), the American Cancer Society, and the American College of Obstetricians and Gynecologists (ACOG).

Screening Guidelines for Average Risk

	Mammogram	Clinical Breast Exam	Breast Self-exam
USPSTF	Age 50 to 74: Mammogram every 2 years. Age 40 to 49: Shared decision with doctor to have a mammogram every 2 years. Age 75 and older: No recommendation given.	No recommendation given.	Not recommended, but encourage breast self-awareness.
American Cancer Society	Age 40 to 44: Women can start screening if that is their choice. Start talking about screening tests with your doctor. Age 45 to 54: Every year. Age 55 and older: Switch to every 2 years, and continue if overall health is good and life expectancy is 10 years or more. A mammogram every year can be done for women who choose to do so.	No recommendation given.	No recommendation given, but encourage breast self-awareness.
ACOG	Age 40 to 49: Shared decision with doctor to have a mammogram every 1 to 2 years. Age 50 to 75 years: Every 1 to 2 years. Age older than 75 years: Shared decision with doctor to continue with mammograms.	Age 25 to 39: Every 1 to 3 years. Age 40 and older: Every year.	Not recommended, but encourage breast self-awareness.

All women should be aware of changes in their breasts, no matter what age. This includes new or disappearing lumps, clear or bloody nipple discharge, dimpling or thickening of the skin, pain, or a feeling of fullness in the underarm area. Not all breast cancers cause symptoms and breast cancer is not the reason for all breast changes. Talk to your doctor about any changes you notice.

Screening Guidelines for High Risk

If you are at high risk for breast cancer, screening tests may be done more often or start at an earlier age.

The American Cancer Society recommends a yearly mammogram with an MRI scan starting at age 30 years for women with:

A high risk score
One of the BRCA genes—if tested
Mother, sister, or child with BRCA genes—if not tested
A history of high-dose radiation to the chest from ages 10 to 30 years
A personal history, or a mother, sister, or child with certain syndromes that increase risk of breast cancer, such as Li-Fraumeni, Cowden, or Bannayan-Riley-Ruvalcaba

The USPSTF recommends:

Monthly breast self-exams for women aged 18 to 21 years
For women aged 25 to 35 years:
- Clinical breast exam every 6 to 12 months
- Yearly mammogram

ACOG recommends that high-risk women consider doing regular breast self-exams.

Screening Tests

There are 3 main tests. Choose which ones you want to do after you talk it over with your doctor. Each one has risks, harms, and benefits:

Breast self-exam—This exam not been shown to lower the risk of death from cancer. If this is something you want to do, talk your doctor first. They will teach you how to do this the right way so it does not cause stress.
Clinical breast exam —The doctor will carefully feel your breasts and under your arms to check for lumps or other changes.
Mammogram—A machine takes an x-ray of the breast. It may find tumors that are too small to be felt. The results depend on many factors such as how dense the breast is. Mammograms will miss breast cancer in 15 of 100 women. It will also find a tumor when one is not there in 30 of 100 women. Despite this, mammograms are the most useful tool to find breast cancer.

Other Imaging Tests

MRI scans may be used to screen high-risk women.

References:

American Cancer Society recommendations for the early detection of breast cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html. Updated October 9, 2017. Accessed March 8, 2019.

Breast cancer: Screening. United States Preventive Services Task Force website. Available at: https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/breast-cancer-screening1. Updated January 2016. Accessed March 8, 2019.

Breast cancer screening. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated July 17, 2018. Accessed March 8, 2019.

1/19/2010 DynaMed's Systematic Literature Surveillance: http://www.dynamed.... Lee CH, Dershaw DD, Kopans D, et al. 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. J Am Coll Radiol. 2010;7(1):18-27.

7/17/2017 DynaMed Plus Systematic Literature Surveillance http://www.dynamed...: Committee on Practice Bulletins—Gynecology. Practice bulletin number 179: breast cancer risk assessment and screening in average-risk women. Obstet Gynecol. 2017;130(1):e1-e16.

Last reviewed December 2018 by EBSCO Medical Review Board Mohei Abouzied, MD, FACP
Last Updated: 3/8/2019

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