From the Guidelines
Yearly breast exams are no longer routinely recommended for average-risk women, and the decision to start screening mammography should be individualized based on a woman's risk factors and preferences, with most women starting at age 45 years. The American Cancer Society guidelines for breast cancer screening have evolved over time, with the most recent update in 2015 1. According to these guidelines, women aged 40-44 have the option to begin annual mammograms, while those 45-54 should get mammograms every year. Women 55 and older can switch to mammograms every two years or continue yearly screening. Some key points to consider when making a decision about breast cancer screening include:
- Women should be informed about the benefits, limitations, and potential harms associated with breast cancer screening, including the risk of false positives and overdiagnosis 1.
- Clinical breast exams by healthcare providers are no longer recommended for average-risk women, though some doctors still perform them 1.
- Monthly breast self-exams are optional, but women should be familiar with how their breasts normally look and feel, reporting any changes to their doctor promptly.
- Women at higher risk, such as those with a family history, genetic mutations like BRCA1/2, or previous radiation therapy, may need earlier or more frequent screening, including MRI 1. The guidelines aim to balance early detection benefits with potential harms, and regular screening is important because early detection of breast cancer, before symptoms develop, allows for more effective treatment options and improved survival rates 1. It's worth noting that the American Cancer Society guidelines are based on the best available evidence and are intended to provide a framework for healthcare providers and women to make informed decisions about breast cancer screening. Ultimately, the decision to start screening mammography should be individualized based on a woman's risk factors, preferences, and values, and should be made in consultation with a healthcare provider.
From the Research
Yearly Breast Exam Guidelines
- The American Cancer Society and other organizations have guidelines for breast cancer screening, but the frequency and methods of screening are still debated 2, 3, 4, 5.
- Clinical breast exams (CBEs) and breast self-exams (BSEs) are two methods of breast cancer screening, but their effectiveness in reducing mortality is still unclear 2, 3, 4, 5.
- A study published in 2022 found that there was no statistically significant difference between CBEs and BSEs in identifying cancer or positive ultrasound findings 2.
- Another study published in 2020 found that BSEs and CBEs might be beneficial in facilitating earlier detection of breast cancer in populations with advanced stages at diagnosis, especially in technically less developed countries 3.
- A 2012 study found that CBEs and BSEs remain important in the era of modern screening, especially for detecting palpable disease in younger women 4.
- A 2020 systematic review found that there was no direct evidence that CBE reduced breast cancer mortality, but indirect evidence suggested that a well-performed CBE achieved the same effect as mammography regarding mortality 5.
- The US Preventive Services Task Force recommends biennial mammography for breast cancer screening in women aged 40 to 74 years, but does not provide specific guidelines for CBEs or BSEs 6.
Recommendations for Breast Cancer Screening
- Women should discuss their individual risk factors and screening options with their healthcare provider to determine the best approach for their breast health 2, 3, 4, 5, 6.
- Breast self-exams and clinical breast exams may be useful in detecting breast cancer, especially in populations with limited access to mammography 2, 3, 4, 5.
- Mammography is still the most widely recommended method of breast cancer screening, especially for women aged 40 to 74 years 6.