What are the breast cancer screening guidelines for men and women?

Breast Cancer Screening Guidelines for Men and Women

For women at average risk of breast cancer, screening mammography should begin at age 45 years with annual screening until age 54, followed by biennial screening at age 55 and older as long as overall health is good and life expectancy is 10 years or more. 1

Screening Guidelines for Average-Risk Women

Age-Based Recommendations

• Women aged 40-44 years should have the opportunity to begin annual screening mammography based on personal preference after discussing potential benefits and harms 1
• Women aged 45-54 years should undergo annual screening mammography (Strong Recommendation) 1, 2
• Women aged 55 years and older should transition to biennial screening or have the opportunity to continue annual screening based on personal preference 1
• Screening should continue as long as a woman is in good health with a life expectancy of 10 years or more 1
• Women aged 75 years or older or with life expectancy less than 10 years should discontinue screening 1

Clinical Breast Examination

• Clinical breast examination is not recommended for breast cancer screening among average-risk women at any age (Qualified Recommendation) 1
• Previous guidelines (pre-2015) had recommended clinical breast examination every 3 years for women aged 20-39 years and annually for women aged 40 years and older 1

Breast Self-Examination

• Routine breast self-examination is not recommended by current guidelines 1
• Women should be aware of their breasts and promptly report any changes to their healthcare provider 1

Risk Assessment and High-Risk Screening

Risk Assessment

• All women should undergo risk assessment by age 25 to identify those at higher-than-average risk 3
• Risk assessment should include evaluation of personal and family history of breast and ovarian cancers in first-degree and second-degree relatives on both maternal and paternal sides 1

High-Risk Women

• Women with genetic mutations (e.g., BRCA1/2), strong family history, or calculated lifetime risk ≥20% should begin screening at an earlier age 3
• Supplemental screening with breast MRI is recommended for high-risk women 3
• Women with prior chest radiation at a young age should begin screening at ages 25-30 3
• Women with a personal history of breast cancer, especially those diagnosed before age 50 or with dense breasts, should undergo annual supplemental breast MRI 3

Screening Guidelines for Men

• There are no routine screening mammography guidelines for average-risk men 4
• Men with genetic mutations (particularly BRCA2) or strong family history may benefit from clinical breast examination and risk assessment 5

Comparison of Guidelines and Evidence Quality

• There is consensus among guidelines that mammography is the gold standard screening modality for average-risk women 4
• The American College of Physicians and American Cancer Society guidelines are considered high quality based on systematic evidence review 1
• Most guidelines recommend screening focus particularly on women aged 50-69 years, where evidence for mortality reduction is strongest 4
• The American College of Radiology and Society of Breast Imaging recommend more aggressive screening starting at age 40, citing potential for 40% mortality reduction with regular screening 6

Benefits and Harms of Screening

Benefits

• Mammography screening is associated with reduced breast cancer mortality 1, 2
• Earlier detection allows for less aggressive treatment options 2, 6
• Screening leads to diagnosis at earlier stages with smaller tumors and fewer node-positive cancers 6

Potential Harms

• False-positive results leading to additional imaging and biopsies 2
• Anxiety and psychological distress from recalls and false positives 2
• Overdiagnosis of cancers that would not have become clinically significant 2
• Radiation exposure (though minimal with modern equipment) 2

Important Considerations for Implementation

• Women should be informed about potential benefits, limitations, and harms of screening before beginning mammography 1
• Screening decisions for women aged 40-44 should involve shared decision-making, as the potential harms may outweigh benefits for many women in this age group 1, 7
• Black women and women of Ashkenazi Jewish heritage should be particularly attentive to risk assessment due to potentially higher risk profiles 3
• Women with dense breasts who desire supplemental screening should consider breast MRI, or if unavailable, contrast-enhanced mammography or ultrasound 3