From the Guidelines
Breast exams are not recommended for breast cancer screening in average-risk women, as the potential harms outweigh the benefits, according to the American College of Physicians guidance statement 1. The most effective screening tool remains mammography, recommended annually or biennially for women starting between ages 40-50 (depending on risk factors) 2, 3. Some guidelines suggest that clinical breast exams may be offered to asymptomatic, average-risk women in the context of an informed, shared decision-making approach, but the evidence for this is limited 4, 5. Breast self-exams are now considered optional rather than essential, with emphasis placed on breast self-awareness—knowing how your breasts normally look and feel so you can report changes to your healthcare provider 6, 7. For high-risk individuals, additional screening with MRI may be recommended 8, 9. Early detection through a combination of screening methods offers the best chance for successful treatment of breast cancer. Key considerations for breast cancer screening include:
- Starting age: 40-50 years old, depending on risk factors
- Screening interval: annually or biennially
- Screening methods: mammography, with potential additional screening with MRI for high-risk individuals
- Breast self-awareness: encouraged, rather than breast self-exams
- Clinical breast exams: not recommended for average-risk women, but may be considered in certain situations.
From the Research
Breast Cancer Screening Recommendations
- 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 10.
- Mammography screening has been proven effective in reducing breast cancer deaths in women age 40 years and older, with a mortality reduction of 40% possible with regular screening 10.
Clinical Breast Examination and Breast Self-Examination
- There is ongoing debate regarding the efficacy of breast self-examination (BSE) and clinical breast examination (CBE) in terms of mortality reduction, and a number of international organizations no longer recommend them as screening methods 11.
- However, in technically less developed countries, where women are usually diagnosed with breast cancer at advanced stages and younger ages, the benefits of BSE and CBE might outweigh the harm and facilitate early detection of breast cancer 11.
Screening for High-Risk Women
- For women at high risk for hereditary breast cancer, recommended surveillance includes regular mammography and clinical breast examination, although the effectiveness of these screening techniques in mutation carriers has not been established 12.
- Breast magnetic resonance imaging (MRI) may be superior to mammography and ultrasound for the screening of women at high risk for hereditary breast cancer, with a higher sensitivity and ability to detect smaller tumors 12.
- Patients at high risk for breast cancer are recommended to undergo annual screening mammography and adjunctive annual screening breast MRI, with alternative options including whole breast ultrasound or contrast-enhanced mammography for those unable to undergo MRI 13.
Comparison of Screening Modalities
- A review of diagnostic performance of MRI, ultrasound, and mammography for detection of breast cancer found that MRI provided the highest sensitivity, while mammography had the lowest sensitivity regardless of breast type, density, and history 14.
- Combining multiple screening modalities, such as MRI + ultrasound or MRI + mammography + ultrasound, can increase diagnostic ability compared to using modalities alone 14.