From the Guidelines
Breast screening is recommended for average-risk women starting at age 50, with regular mammography screening every 2 years until age 69. This recommendation is based on the most recent and highest quality study, which suggests that regular mammography screening in this age group can reduce breast cancer mortality and morbidity 1.
Key Recommendations
- Average-risk women should undergo regular mammography screening every 2 years from age 50 to 69.
- Women with a strong family history or known germline BRCA1/2 and other high-risk pathogenic variants should follow the ESMO CPG for risk reduction and screening of cancer in hereditary breast-ovarian cancer syndromes 1.
- Digital breast tomosynthesis (with or without synthetic mammography) and contrast-enhanced mammography can be considered as alternatives to traditional mammography, where available and appropriate 1.
- Magnetic resonance imaging (MRI) of the breasts is recommended in case of uncertainties following standard imaging and in special clinical situations 1.
Screening Process
The screening process involves a mammogram, which is an X-ray of the breast tissue that can detect abnormalities before they become palpable. Digital breast tomosynthesis (3D mammography) offers improved detection rates compared to traditional 2D mammography.
Importance of Screening
Screening is crucial because early detection of breast cancer significantly improves treatment outcomes and survival rates. The benefits of early detection outweigh the potential harms of false positives or unnecessary biopsies. Women should also perform monthly breast self-examinations and report any changes to their healthcare provider immediately. Regular clinical breast examinations by healthcare professionals complement mammographic screening and should be performed annually.
High-Risk Factors
Those with high-risk factors such as family history of breast cancer, BRCA1/2 gene mutations, or previous chest radiation therapy should begin screening earlier and may benefit from additional imaging like MRI 1.
Conclusion Not Applicable
As per the guidelines, the response should not include a conclusion section. The information provided is based on the most recent and highest quality study, which prioritizes morbidity, mortality, and quality of life as the outcome 1.
From the Research
Breast Screening Recommendations
- The U.S. Preventive Services Task Force (USPSTF) and American Academy of Family Physicians (AAFP) recommend biennial screening mammography for average-risk women 50 to 74 years of age 2
- For average-risk women 40 to 49 years of age, the USPSTF and AAFP recommend individualized decision-making due to insufficient evidence supporting a net benefit of mammography screening 2
- Women at high risk of breast cancer may benefit from mammography starting at 30 years of age or earlier, with supplemental screening such as magnetic resonance imaging (MRI) 2, 3
Screening Modalities
- MRI is more sensitive for detecting breast cancers than mammography, ultrasound, or clinical breast examination (CBE) alone in BRCA1 and BRCA2 mutation carriers 3
- A review of diagnostic performance of MRI, ultrasound, and mammography for detection of breast cancer found that MRI provided the highest sensitivity, while mammography showed the lowest sensitivity 4
- Combining the results of all three techniques (MRI, ultrasound, and mammography) resulted in a sensitivity of 97.7% and a specificity of 63.3% 4
Surveillance of High-Risk Women
- A study comparing the utility of clinical breast examination and MRI in the surveillance of women with a high risk of breast cancer found that MRI had a higher cancer detection rate (1.6%) compared to CBE (0%) 5
- The same study suggested that CBE may not be a critical component of the surveillance programme of high-risk women, due to its low cancer detection rate 5