What are the recommendations for breast exams and screenings?

Breast Cancer Screening Recommendations

For average-risk women, begin annual screening mammography at age 40, transition to biennial screening at age 55 if desired, and continue as long as life expectancy exceeds 10 years. 1

Screening by Age Group

Ages 40-44

• Women should have the opportunity to begin annual screening mammography starting at age 40. 1
• The American College of Radiology strongly recommends annual mammography beginning no later than age 40 for all average-risk women. 1, 2
• Starting at age 40 rather than 45 or 50 provides greater mortality reduction (up to 40% with regular screening) and allows detection of earlier-stage disease. 1, 2
• However, be aware that false-positive results and unnecessary biopsies are more common in women aged 40-49 compared to older women, and the absolute number of deaths averted is smaller in this age group. 3

Ages 45-54

• Annual screening mammography is strongly recommended for women aged 45-54. 1
• This age group has the strongest evidence for annual screening benefit. 1

Ages 55-74

• Women should transition to biennial screening at age 55, though annual screening remains an option based on individual preference. 1
• Biennial screening provides adequate benefit with fewer false-positives for women 55 and older. 1
• The USPSTF recommends biennial screening for ages 50-74 as providing the best balance of benefits and harms. 3
• For most women, biennial mammography screening provides the best overall balance of benefit and harms in this age range. 3

Ages 75 and Older

• Continue screening mammography as long as overall health is good and life expectancy exceeds 10 years. 1, 4
• There is no agreed-upon upper age limit for screening. 1
• Screening decisions should be based on life expectancy and comorbidities rather than age alone. 1
• The American College of Physicians recommends stopping screening in women with life expectancy less than 10 years. 4

Mortality Benefit

• Mammography screening reduces breast cancer mortality by at least 22% in randomized trials, with observational studies showing up to 40% reduction in women who are actually screened. 1, 2
• Beginning screening at age 40 versus age 45 or 50 results in greater mortality reduction and diagnosis at earlier stage with better surgical options. 1, 2
• Delaying screening until age 45 or 50 will result in unnecessary loss of life to breast cancer and adversely affects minority women in particular. 2

Clinical Breast Examination and Breast Self-Examination

• Clinical breast examination is not recommended as a standalone screening method for average-risk women. 1
• The USPSTF recommends against teaching breast self-examination (BSE) as evidence shows it does not reduce mortality and increases unnecessary biopsies. 3
• There is insufficient evidence that clinical breast examination (CBE) affects breast cancer mortality. 3

High-Risk Women Requiring Earlier Screening

• Women with family history of breast cancer should begin screening 10 years prior to the youngest age at presentation in the family, but generally not before age 30. 1, 5
• Women with lobular neoplasia or atypical hyperplasia diagnosed before age 40 should undergo annual screening from time of diagnosis, but generally not before age 30. 1, 5
• Women with personal history of breast cancer require annual surveillance mammography. 1, 5
• Women with BRCA1/BRCA2 mutations or history of chest radiation (especially for Hodgkin's disease) require earlier and more frequent screening. 3, 1, 5

Important Caveats

• Approximately 10% of screening mammograms result in recall for additional imaging, though less than 2% result in biopsy recommendation. 1
• Ensure referral to accredited mammography facilities with proper quality assurance standards. 1, 3
• Quality guidelines recommend a delay of no more than 60 days between screening and diagnosis for abnormal results, as longer delays are associated with poorer outcomes. 4
• Digital breast tomosynthesis increases cancer detection rates by 1.6-3.2 per 1,000 examinations compared to standard digital mammography. 1

Guideline Discordance to Be Aware Of

• The American Cancer Society recommends starting screening at age 45 as a strong recommendation, with optional screening at 40-44. 1
• The USPSTF recommends biennial screening starting at age 50, with individualized decisions for ages 40-49. 3
• Despite this discordance, the most recent high-quality evidence supports offering annual screening starting at age 40 to maximize mortality reduction. 1, 2