Breast Cancer Screening

Recommendations for Mammography :

A Public Outreach Project

Breast cancer is the most common cancer in women worldwide (1).

Breast cancer continues to rank second, after lung cancer, as a cause of cancer death in women in the United States, and it is a leading cause of premature mortality for women (1).

Breast Cancer

Benefits of Mammography

Screening mammograms can be used to check for breast cancer in women with no signs or symptoms of the disease.

Mammography can be used to screen women in order to reduce their risk of death from breast cancer.

In RCTs, for women aged 40-74 years, screening with mammography has been associated with a 15% to 20% relative reduction in mortality from breast cancer (3). This benefit is age dependent and the strongest evidence for the greatest benefit is among women aged 60 to 69 years (2, 4).

High risk women (with a parent, sibling, or child with breast cancer) may benefit more than average-risk women from beginning screening in their 40s (4)

In addition to false-positive results and unnecessary biopsies, screening mammography increases the risk for diagnosis and treatment of noninvasive and invasive breast cancer that would otherwise not have become a threat to patients health, or even apparent, during their lifetime (Overdiagnosis).

Screening at a younger age / screening more frequently may increase the risk for overdiagnosis and subsequent overtreatment.

Other harms include pain, and radiation exposureTheoretically, annual mammograms in women aged 40

to 80 years may cause up to one breast cancer per 1,000 women (3, 4).

Risks of Mammography

Recommendations for breast cancer screening from major Organizations

U.S. Preventive Services Task Force (USPSTF) Women aged 50 to 74 years: biennial screening mammographyWomen aged 40 to 49 years:

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• Based on patient preference (Women who place a higher value on the potential benefit than the potential harms) • Women with a parent, sibling, or child with breast cancer are at higher risk for breast cancer and thus may benefit more than average-risk women from beginning screening in their 40s.

Women aged 75 years or older: the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women aged 75 years or older.

Recommendations for breast cancer screening from major Organizations

American College of Obstetricians and Gynecologists (ACOG)• For women at average risk, health care providers should

discuss the benefits and harms of Annual screening mammography starting at age 40 years.

• Health care providers should work with patients to determine the best screening strategy based on individual risk and values. In some women, biennial screening may be a more appropriate or acceptable strategy. Some average-risk women may prefer biennial screening, which maintains most of the benefits of screening while decreasing both the frequency of screening and the potential for additional testing, whereas other women may prefer annual screening because it maximizes cancer detection.

• The decision of when to start screening, the frequency of screening, and when to end screening should be made through shared decision making, with consideration of individual patient values and preferences about the potential benefits and consequences of screening.

Recommendations for breast cancer screening from major Organizations

American Cancer Society (ACS)• Women with an average risk of breast cancer should

undergo regular screening mammography starting at age 45 years (strong recommendation = benefits of adherence to the intervention outweigh the undesirable effects).

• Women should have the opportunity to begin annual screening between the ages of 40 and 44 years (qualified recommendation = clear evidence of benefit but less certainty on “balance of benefits/harms, or patients preferences.

• Women aged 45 to 54 years should be screened annually (qualified recommendation).

• Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation).

• Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer (qualified recommendation).

Recommendations for breast cancer screening from major Organizations

American College of Radiology (ACR)• Annual screening mammography for women starting at

age 40.

• Age 25-30 for BRCA 1 carriers & untested relatives of BRCA carriers

• age 25-30 or 10 years earlier than the age of the affected relative at diagnosis (whichever is later) for women with a first-degree relative with premenopausal breast cancer or for women with a lifetime risk of breast cancer ≥20% on the basis of family history

There is no established age for women to stop screening. Women should continue breast cancer mammography screening as long as they are healthy and desire to remain so. Therefore, health care coverage for screening should not have an upper age limit.

Recommendations for breast cancer screening from major Organizations

National Cancer Institute (NCI) Start at age of 40 years and older, every 1-2 years

1) Kevin C, Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update from the American Cancer Society; JAMA. Author manuscript; available in PMC 2016 Apr 14.

2) Bryan TJ, et al. Impact of an educational intervention on provider knowledge, attitudes, and comfort level regarding counseling women ages 40-49 about breast cancer screening. J Multidiscip Healthc. 2015 May 4;8:209-16.

3) https://www.cancer.gov/types/breast/hp/breast-screening-pdq

4)https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/breast-cancer-screening1

References