Screening for Breast Cancer
Screening is done to find a problem and treat it early. Tests are given to people who do not have symptoms but who may be at high risk.
Screening guidelines differ and can be confusing. The doctor can advise how often a person should be screened.
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
|Â||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.|
- 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
Screening Guidelines for High Risk
Those at high risk for breast cancer may be screened more often or 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:
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 regular breast self-exams.
There are 3 main tests that the doctor may advise. Each one has risks, harms, and benefits:
- Breast self-exam—This exam not been shown to lower the risk of death from cancer. The doctor can show a person how to do the exam the correct way.
- Clinical breast exam—The doctor will carefully feel the breasts and under the arms. This is 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. Mammograms miss breast cancer in some women. Sometimes they also appear to show a tumor when one is not there. Despite this, they are the most useful tool to find breast cancer.
Other Imaging Tests
MRI scans may be used to screen high-risk women.
- 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.
- Breast cancer: Screening. United States Preventive Services Task Force website. Available at: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening.
- Breast cancer screening. EBSCO DynaMed website. Available at: https://www.dynamed.com/prevention/breast-cancer-screening.
- 7/17/2017 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T361086/Breast-cancer-screening: 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.
- Mohei Abouzied, MD, FACP
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