Screening modalities — Screening mammography has been shown to lower deaths from breast cancers. Mammography (digital or film) is the primary modality for breast cancer screening in average-risk women. Other techniques, such as ultrasound and magnetic resonance imaging (MRI), are useful for further evaluation of findings on mammography or for the screening of women at a higher risk for breast cancer. Breast examination by the clinician or by the patient is not recommended as the only screening method, and it is controversial as to whether clinician breast exam or patient breast self-exam (BSE) is beneficial as an adjunct to mammography. But it is important to educate women about breast awareness and to encourage women to report any breast concerns. The following are the recommendations by different societies for routine mammographic screening in women at average risk.
|40 to 49 years of age||50 to 69 years of age||≥70 years of age|
|US Preventive Services Task Force (2016)||Two||Individualize*||yes||Yes, to the age of 74|
|American Cancer Society (2015)||One year age 45 to 54
One to two years age ≥55
|Individualize* through age 44
Yes, start age 45
|National Comprehensive Cancer Network (2018)||One||yes||yes||yes|
* Women should be counseled about the harms and benefits of mammography; individualized decisions should include shared decision-making based on risks, benefits, patient values and preferences.
Δ If in good health and life expectancy >10 years.
Above average risk or high risk of breast cancer is associated with a personal history of breast, ovarian, tubal, or peritoneal cancer or family history of breast, ovarian, tubal, or peritoneal cancer. Other factors associated with a high risk of breast cancer are a family history of hereditary breast and ovarian cancer syndrome (eg. Mutations of BRCA1 or BRCA2, PTEN, TP5) in self or relative. The screening in this population should begin 10 years prior to the youngest family member with breast cancer but not before the age of 25-30 years. The other group of patients at high risk of developing breast cancer is those with prior history of chest irradiation between age 10-30 years. These patients should be started on screening protocols beginning 10 years after radiation therapy. Both annual mammogram and breast MRI are recommended for screening of high-risk patients. The risk and benefits of screening should always be discussed at length with the individual as this can lead to overdiagnosis, anxiety and more biopsies that were not needed.