What are the breast cancer screening guidelines for average-risk women?

From the Guidelines

Breast cancer screening for average-risk women should start at age 45 with annual mammography until age 54, then transition to biennial screening at age 55 and older, as recommended by the American Cancer Society 1.

Key Recommendations

• Women aged 45-54 years should undergo annual screening mammography 1.
• Women aged 55 years and older should transition to biennial screening or have the opportunity to continue screening annually 1.
• Women should have the opportunity to begin annual screening between ages 40 and 44 years 1.
• Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or more 1.

Considerations

• The decision to start screening should involve a discussion between patient and provider about personal risk factors, preferences, and values 1.
• Women with a family history of breast cancer or genetic risk factors may need earlier or more frequent screening than these general guidelines suggest 1.
• Clinical breast examination is not recommended for breast cancer screening among average-risk women at any age 1.

Evidence Quality

The American Cancer Society's guidelines are based on a systematic evidence review and a supplemental analysis of mammography registry data 1. The American College of Physicians' guidance statement is based on an appraisal of selected guidelines and their included evidence 1. The U.S. Preventive Services Task Force recommends biennial mammography from ages 50-74, with individualized decisions for women 40-49 1.

From the Research

Breast Cancer Screening Guidelines

The breast cancer screening guidelines for average-risk women vary among national health organizations. Key points to consider include:

• 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, there is no strong evidence supporting a net benefit of mammography screening, and the USPSTF and AAFP recommend individualized decision-making 2.
• The American College of Obstetricians and Gynecologists and the American Cancer Society state that screening may continue for average-risk women 75 years and older, depending on the woman's health status and life expectancy 2.
• Regular screening mammography starting at age 40 years reduces breast cancer mortality in average-risk women, but also exposes women to harm through false-positive test results and overdiagnosis of biologically indolent lesions 3, 4.
• Most specialty societies agree that physicians should offer mammographic screening at age 40 years for average-risk women and discuss its benefits and potential harms to achieve a personalized screening strategy through a shared decision-making process 5.

Screening Recommendations

Some of the key recommendations for breast cancer screening in average-risk women include:

• Biennial screening mammography for women 50 to 74 years of age 2.
• Individualized decision-making for women 40 to 49 years of age 2.
• Consideration of a woman's health status and life expectancy when deciding whether to continue screening at 75 years and older 2.
• Discussion of the benefits and potential harms of screening to achieve a personalized screening strategy 5.
• Use of a risk assessment tool to determine individual risk and guide screening decisions 2.