From the Guidelines
The USPSTF recommends biennial screening mammography for women aged 50 to 74 years. For women aged 40 to 49 years, the decision to start screening should be individualized, taking into account the patient's values regarding specific benefits and harms 1. The USPSTF found insufficient evidence to assess the benefits and harms of screening mammography in women 75 years and older. These recommendations are based on evidence showing that mammography reduces breast cancer mortality, with the greatest benefit occurring in women aged 50-74 1.
Key Points
- Biennial screening mammography is recommended for women aged 50 to 74 years
- Individualized decision-making is recommended for women aged 40 to 49 years
- Insufficient evidence exists to assess the benefits and harms of screening mammography in women 75 years and older
- The biennial screening interval provides most of the benefit of annual screening with fewer harms such as false positives, unnecessary biopsies, and overdiagnosis
- Women with a family history of breast cancer may benefit more from beginning screening in their 40s The guidelines aim to balance the benefits of early detection against potential harms of screening, including anxiety, unnecessary procedures, and treatment of cancers that might never have caused symptoms 1.
From the Research
USPSTF Guidelines for Mammography
- The USPSTF recommends biennial screening with mammography for women aged 50-74 years 2.
- For women aged 40-49 years, the decision to start regular, biennial screening mammography should be an individual decision and take patient context into account, including patient values regarding specific benefits and harms 2, 3.
- The USPSTF found that biennial mammography screening commenced at age 50 and continuing until age 74 years achieves maximal benefit in breast cancer mortality with least harms 2.
- A small additional benefit could be realized if screening starts at age 40 years, but the potential harms of screening with this regimen are minor 4.
- The American Cancer Society (ACS) recommends annual screening for women aged 45-54, who may transition to biennial after 55 5.
Changes in Screening Intervals
- The 2009 USPSTF recommendation did not lengthen the average mammography interval among women routinely participating in mammography screening 6.
- The mean interval minimally decreased after the 2009 USPSTF recommendations, with small reductions seen for most age groups 6.
- The largest change in interval length in the post-USPSTF period was declines among women with a first-degree family history of breast cancer or a 5-year breast cancer risk ≥2.5% 6.