American Cancer Society Breast Cancer Screening

Why Are There Different Screening Recommendations For Women Ages 40

Mammography in women ages 40-49 may lower the risk of dying from breast cancer, though the benefit is less than for older women . Some major health organizations have concluded the modest potential benefits of mammography for women in their 40s outweigh the risks of over-diagnosis, over-treatment and false positive results .

Komen believes all women should have access to regular screening mammograms when they and their health care providers decide it is best based on their personal risk of breast cancer.

The American Cancer Society states women ages 40-44 should have the option to have a mammogram every year . It recommends routine mammography starting at age 45 .

The National Comprehensive Cancer Network recommends routine mammography for women starting at age 40 .

The U.S. Preventive Services Task Force, as well as the American College of Physicians, recommends women 40-49 talk with their health care providers about their risk of breast cancer and the pros and cons of mammography. Then, together, make informed decisions about when to start mammography screening and how often to get screened .

Informed decisions are guided by a womans breast cancer risk profile. Women at higher than average risk of breast cancer are more likely to benefit from mammography .

Talk with your health care provider about when to start mammography screening.

Learn more about weighing the benefits and risks of mammography, including information on over-diagnosis and over-treatment.

If You Are Age 40 And Over:

• Have a mammogram every year
• Have a clinical breast exam by your health care provider every year
• Do a breast self-exam each month

Ask your health care provider to teach you the proper way to do a thorough breast self-exam. .

If you have a history of breast cancer in your family, discuss mammography screening guidelines and scheduling with your health care provider.

Benefits Of Mammographic Screening

The ACS systematic review also examined the effect of screening mammography on life expectancy. Although the review concluded that there was high-quality evidence that mammographic screening increases life expectancy by decreasing breast cancer mortality, the authors were not able to estimate the size of the increase 23.

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History Of Acs Recommendations For The Early Detection Of Cancer In People Without Symptoms

The following tables give the history of cancer detection tests that have been recommended by the American Cancer Society for people who are at average risk for cancer and do not have any specific symptoms. These recommendations have changed over time as new tests have become available and as more evidence for or against the value of some of these tests has emerged.

People who are at increased risk for certain cancers may need to follow a different testing schedule, such as starting at an earlier age or being tested more often. Those with symptoms that could be related to cancer should see their doctor right away.

This is not meant to be an official document for American Cancer Society recommendations.

What Are The Limitations Of Mammography And Why Is It Important For Women Know About Them

Mammography is the best test we have at this time to find breast cancer early, but it has known limitations — it will find most, but not all, breast cancers. The American Cancer Society supports informing women about the limitations of mammography so they will have reasonable expectations about its accuracy and usefulness. Studies show that informing women of the limitations of mammography before they have one decreases anxiety and improves later adherence with screening recommendations.

The accuracy of mammography improves as women age thus, accuracy is slightly better for women in their 50s than women in their 40s and slightly better for women in their 60s than women in their 50s, and so on. However, a woman undergoing breast cancer screening needs to know that mammography at any age is not 100% accurate. Overall, mammography will detect about 85% of breast cancers.

Women also need to be prepared for the possibility of being called back for additional testing, even though most women who get further testing do not have breast cancer. On average, about 10% of women are recalled for further evaluation, including additional mammography and/or ultrasound, and sometimes a biopsy to determine if cancer is present.

Women also need to know that if their mammogram result is normal, but they detect a symptom months later before their next mammogram, they should see a doctor right away.

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Why Surgeons Are Concerned About Delayed Cancer Screenings

• Surgeons play a unique role in caring for patients through their breast cancer journeytreating both women and men who are diagnosed with the disease and guiding them in the surgical decision-making process that frequently accompanies their diagnosis.

• If an operation is recommended as treatment for breast cancer, surgeons typically prefer to treat a patient earlier rather than later for breast cancer.
• The operation is less aggressive and usually is shorter in duration than treating a patient with an advanced tumor.
• Recovery time is quicker too, meaning the patient can get back out into her world sooner too, with less time off work, and less time away from family and other responsibilities.

How Common Is Breast Cancer

• Excluding skin cancers, breast cancer is the most common cancer diagnosed among women in the United States.
• Black women experience worse outcomes and higher death rates compared with white women. This disparity has been reported for years in the medical literature. In fact, more black women die from breast cancer than any other type of cancer, according to the American Cancer Society. The medical community is aware of this disparity and research is ongoing to improve health equity. Women should not be afraid to speak up and advocate for themselves.
• Although the incidence of breast cancer is approximately 30% lower in Hispanic individuals compared to white women, invasive breast cancer is the leading cause of cancer death among Hispanic women in the United States.
• Men are impacted, tooabout 1 out of every 100 breast cancers diagnosed in the United States is found in a man, according to the CDC.

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Clinical Breast Exam And Breast Self

Research has not shown a clear benefit of regular physical breast exams done by either a health professional or by women themselves . There is very little evidence that these tests help find breast cancer early when women also get screening mammograms. Most often when breast cancer is detected because of symptoms , a woman discovers the symptom during usual activities such as bathing or dressing. Women should be familiar with how their breasts normally look and feel and should report any changes to a health care provider right away.

While the American Cancer Society does not recommend regular clinical breast exams or breast self-exams as part of a routine breast cancer screening schedule, this does not mean that these exams should never be done. In some situations, particularly for women at higher-than-average risk, for example, health care providers may still offer clinical breast exams, along with providing counseling about risk and early detection. And some women might still be more comfortable doing regular self-exams as a way to keep track of how their breasts look and feel. But its important to understand that there is very little evidence that doing these exams routinely is helpful for women at average risk of breast cancer.

Why Is It Important To Get Screened For Breast Cancer

• Patients survival rates are typically higher if breast cancer is detected early.
• Dont fear the mammogram. After the exam, the news is usually good:
• According to the American College of Radiologists, most women will receive a normal mammogram result.
• Out of every 100 women who receive a screening mammogram, only 10 will be asked to return for additional mammograms or ultrasounds, and out of those 10 women, only two will be recommended to have a needle biopsy.

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Improving Breast And Cervical Cancer Screening Rates

The Affordable Care Act is helping to improve insurance coverage, raise awareness, and reduce the costs of breast and cervical cancer screenings for women, by requiring private insurers, Medicare, and Medicaid expansion programs to cover routine preventive services at no cost to the patient. However, millions of underinsured and uninsured women across the country still do not have access to these lifesaving screenings. Low-income women, particularly minorities, often face later stage cancer diagnoses have less access to diagnostic and treatment services and lower survival rates.

How Benign Are Benign Breast Findings Study Finds Link To Higher Cancer Risk

TUESDAY, Nov. 22, 2022 Many women feel a lump in their breast or receive an abnormal result on a screening mammogram that turns out to be a cyst or other type of non-cancerous growth.

With this news comes a huge sigh of relief, but it may not be the end of the story, new research suggests.

While these growths are not cancerous, their presence may increase the risk of breast cancer down the road. Women who have benign breast conditions, such as cysts and fibroadenomas, are almost twice as likely to be diagnosed with breast cancer in the next 20 years, researchers from Spain reported.

The new findings should encourage women with benign breast lesions to participate in breast cancer screening programs because they are at an increased risk and they might benefit a higher degree of breast cancer early detection, said study author , an epidemiologist at the Hospital del Mar in Barcelona.

Because women with a benign breast disease are at an increased risk for breast cancer, the information on benign breast disease, together with information on density, age, and family history of breast cancer can be used to define risk groups to design personalized screening strategies, she said.

In Spain, women between 50 and 69 years of age are screened for breast cancer every two years. The American Cancer Society suggests women between 45 and 54 years of age get mammograms every year. After that, older women can switch to every other year or continue yearly screening.

More information

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How Often Should Women Ages 50

The American Cancer Society recommends mammography every year for women ages 50-54 and every 1-2 years for women ages 55 and older .

The NCCN recommends women 50-69 have mammograms every year .

The U.S. Preventive Services Task Force recommends mammography every 2 years for women 50-69 . The Task Force reviewed the scientific evidence and concluded mammography every 2 years gives almost as much benefit as mammography every year while reducing risks . These risks include

Why Is A Clinical Breast Exam No Longer Recommended

Clinical breast examination is a physical exam done by a health professional. During the beginning of the mammography era, the combination of CBE and mammography was associated with a lower risk of dying from breast cancer, and CBE was shown to offer an independent contribution to breast cancer detection. Since then, as mammography has improved and womens awareness and response to breast symptoms has increased, the few studies that exist suggest that CBE contributes very little to early breast cancer detection in settings where mammography screening is available and awareness is high.

In addition, there was moderate evidence that doing CBE along with mammography increases the rate of false positives. Based on this information, the current guideline does not recommend CBE for US women at any age.

There are settings in the US where access to mammography remains a challenge, and the American Cancer Society will continue to work to ensure that all women have access to mammography screening. We recognize that some health care providers will continue to offer their patients CBE, and there may be instances when a patient decides with their health care provider to have the exam- and that’s OK. The important message of our guideline is that CBE should not be considered an acceptable alternative to mammography screening, no matter the challenges of access to mammography.

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How Does This Guideline Differ From Previous Acs Guidelines

The biggest change in the current guideline is that we now recommend that women at average risk for breast cancer start annual screening with mammograms at age 45, instead of age 40 . Women ages 40 to 44 can choose to begin getting mammograms yearly if they want to.

In addition, the guideline says that women should transition to screening every 2 years starting at age 55, but can also choose to continue screening annually.

The ACS no longer recommends a clinical breast exam as a screening method for women in the U.S. Breast self-exam is also no longer recommended as an option for women of any age.

Mammography Guidelines: When To Start

• Most health agencies recommend that women 40 and over who are at average risk of developing breast cancer should receive a mammogram once every year or every two years.
• Ultimately, the decision should be made between a patient and her physician. Women should discuss their breast cancer risk with their primary care physician or gynecologist, who can advise them on when to begin screening, and how often to have screening after their first mammogram.

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Why Did Acs Change Its Guideline To Say Routine Screening Should Start At 45 Instead Of 40

The evidence shows that the risk of cancer is lower for women ages 40 to 44 and the risk of harm from screenings is somewhat higher. Because of this, a direct recommendation to begin screening at age 40 was no longer warranted. However, because the evidence shows some benefit from screening with mammography for women between 40 and 44, the guideline committee concluded that women in this age group should have the opportunity to begin screening based on their preferences and their consideration of the tradeoffs. That balance of benefits to risks becomes more favorable at age 45, so annual screening is recommended starting at this age.

Every life lost to cancer is important. But the fact is, even though mammography reduces deaths from breast cancer, it does not eliminate them, even in the age groups where it is agreed that women should be screened. The challenge of screening is maximizing the lifesaving benefits while minimizing its harms. These evidence-based guidelines represent the best current thinking on that balance.

American Cancer Society Screening Recommendations For Women At High Risk

Women who are at high risk for breast cancer based on certain factors should get a breast MRI and a mammogram every year, typically starting at age 30. This includes women who:

• Have a lifetime risk of breast cancer of about 20% to 25% or greater, according to risk assessment tools that are based mainly on family history
• Have a known BRCA1 or BRCA2 gene mutation
• Have a first-degree relative with a BRCA1 or BRCA2 gene mutation, and have not had genetic testing themselves
• Had radiation therapy to the chest when they were between the ages of 10 and 30 years
• Have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromes

The American Cancer Society recommends against MRI screening for women whose lifetime risk of breast cancer is less than 15%.

Theres not enough evidence to make a recommendation for or against yearly MRI screening for women who have a higher lifetime risk based on certain factors, such as:

• Having a personal history of breast cancer, ductal carcinoma in situ , lobular carcinoma in situ , atypical ductal hyperplasia , or atypical lobular hyperplasia
• Having extremely or heterogeneously dense breasts as seen on a mammogram

If MRI is used, it should be in addition to, not instead of, a screening mammogram. This is because although an MRI is more likely to find cancer than a mammogram, it may still miss some cancers that a mammogram would find.

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American Cancer Society Screening Recommendations For Women At Average Breast Cancer Risk

The COVID-19 pandemic has resulted in many non-emergency procedures being put on hold. This has led to a substantial decline in cancer screening. Health care facilities are providing cancer screening during the pandemic with many safety precautions in place. Learn how you can talk to your doctor and what steps you can take to plan, schedule, and get your regular cancer screenings in Cancer Screening During the COVID-19 Pandemic.

These guidelines are for women at average risk for breast cancer. For screening purposes, a woman is considered to be at average risk if she doesnt have a personal history of breast cancer, a strong family history of breast cancer, or a genetic mutation known to increase risk of breast cancer , and has not had chest radiation therapy before the age of 30.

• Women between 40 and 44 have the option to start screening with a mammogram every year.
• Women 45 to 54 should get mammograms every year.
• Women 55 and older can switch to a mammogram every other year, or they can choose to continue yearly mammograms. Screening should continue as long as a woman is in good health and is expected to live at least 10 more years.
• All women should understand what to expect when getting a mammogram for breast cancer screening what the test can and cannot do.

Clinical breast exams are not recommended for breast cancer screening among average-risk women at any age.