What are the guidelines for breast cancer screening using Mammography (mammography)?

From the Guidelines

Breast cancer screening is recommended for women starting at age 40 with annual mammograms, as it has been shown to decrease breast cancer mortality by at least 22% [ 1 ].

Key Recommendations

• Women at average risk should continue screening annually until age 75, after which decisions should be individualized based on health status and life expectancy.
• Those with higher risk factors—such as family history of breast cancer, genetic mutations like BRCA1/2, or previous chest radiation—should begin screening earlier, typically at age 30, and may benefit from additional imaging like breast MRI.
• Clinical breast exams by healthcare providers are not recommended for breast cancer screening among average-risk women at any age [ 1 ].
• Self-breast awareness is also important, with women encouraged to become familiar with their normal breast appearance and report any changes to their healthcare provider.

Rationale

The benefits of mammography screening in reducing breast cancer mortality are well-established, with a reduction of at least 22% [ 1 ].

• The American College of Radiology recommends that women continue screening as long as they remain in overall good health and are willing to undergo the examination and subsequent testing or biopsy, if an abnormality is identified [ 1 ].
• The American Cancer Society also recommends annual screening for women aged 40-54, and biennial screening for women aged 55 and older [ 1 ].

Considerations

• The risks of screening, including false-positive recalls and biopsies, overdiagnosis, and patient anxiety, should be discussed with patients [ 1 ].
• The decision to continue screening should be based on individual factors, including health status and life expectancy [ 1 ].
• Women should be informed about the benefits, limitations, and potential harms associated with regular screening [ 1 ].

From the Research

Guidelines for Breast Cancer Screening using Mammography

• The American College of Radiology (ACR) and Society of Breast Imaging recommend annual mammography screening beginning at age 40, which provides the greatest mortality reduction, diagnosis at earlier stage, better surgical options, and more effective chemotherapy 2, 3.
• Screening should continue past age 74 years, without an upper age limit unless severe comorbidities limit life expectancy 2.
• The benefits of screening should be considered along with the possibilities of recall for additional imaging and benign biopsy and the less tangible risks of anxiety and overdiagnosis 2, 3.
• Annual screening results in more screening-detected tumors, tumors of smaller sizes, and fewer interval cancers than longer screening intervals 2.
• Delaying screening until age 45 or 50 will result in an unnecessary loss of life to breast cancer and adversely affects minority women in particular 2.

Effectiveness of Breast Cancer Screening

• Mammography screening has consistently been shown to significantly reduce breast cancer mortality over a variety of study designs 3, 4.
• The relative risks for breast cancer mortality with mammography screening are 0.92 for women aged 39 to 49 years, 0.86 for those aged 50 to 59 years, 0.67 for those aged 60 to 69 years, and 0.80 for those aged 70 to 74 years 4.
• Advanced breast cancer is reduced for women aged 50 years or older with screening, but not those aged 39 to 49 years 4.

Screening Strategies for High-Risk Women

• For women with ATM, CHEK2, and PALB2 pathogenic variants, annual MRI screening starting at 30 to 35 years followed by annual MRI and mammography at 40 years may reduce breast cancer mortality by more than 50% 5.
• In the setting of MRI screening, mammography prior to 40 years may offer little additional benefit 5.
• The estimated lifetime breast cancer risk is 20.9% for women with ATM pathogenic variants, 27.6% for women with CHEK2 pathogenic variants, and 39.5% for women with PALB2 pathogenic variants 5.