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 suggests that women with a parent, sibling, or child with breast cancer may benefit more from beginning screening in their 40s.
Key Points
- For women aged 50 to 74 years, biennial screening mammography is recommended to reduce breast cancer mortality.
- For women aged 40 to 49 years, the decision to start screening should be individualized, considering the patient's values and risk factors.
- There is insufficient evidence to assess the balance of benefits and harms of screening mammography for women aged 75 and older.
- The USPSTF does not recommend teaching breast self-examination and finds insufficient evidence to assess the benefits and harms of clinical breast examination 2.
Considerations
- The recommendations are based on evidence showing that mammography reduces breast cancer mortality while considering potential harms such as false-positive results, unnecessary biopsies, and overdiagnosis.
- Digital breast tomosynthesis (3D mammography) can be considered as an alternative to standard 2D mammography, though more research is needed on long-term outcomes.
- Clinicians should inform women about the potential benefits and harms of screening mammography and involve them in the decision-making process.
From the Research
USPSTF Guidelines for Mammography
- The USPSTF recommends biennial screening with mammography for women aged 50−74 years 3, 4, 5.
- For women aged 40-49 years, the decision to start regular screening mammography should be an individual one, taking into account patient values regarding specific benefits and harms 6, 7.
- The USPSTF does not recommend routine mammogram screening for women aged 40-49 years at average risk for breast cancer 7.
- Annual screening mammography from ages 40-84 years would save more lives than the USPSTF-recommended regimen of biennial screening of women 50-74 years old 3.
Benefits and Harms of Screening Mammography
- Screening mammography shows the greatest benefit, a 39.6% mortality reduction, from annual screening of women 40-84 years old 3.
- The potential harms of a screening examination in women 40-49 years old include the risk of a recall for diagnostic workup, a negative biopsy, a missed breast cancer, and a fatal radiation-induced breast cancer 3, 6.
Adherence to USPSTF Guidelines
- Most women (80%) are unaware of the USPSTF screening guideline related to age of initiation and frequency of mammography 7.
- Being aware of the recommendation to initiate screening at age 50 increases the odds of not initiating screening, whereas being older than 45 years and having a primary care doctor decreases the odds of not initiating screening 7.
- Mammogram screening in excess of USPSTF recommendations is prevalent among U.S. women aged 40-49 years 7.