Mammography in Breast Cancer Guidelines

Updated: Oct 18, 2016
  • Author: Nagwa Dongola, MD, FRCR; Chief Editor: Peter Eby, MD  more...
  • Print
Guidelines

Guidelines Summary

Guidelines on breast cancer screening have been issued by the following organizations [37, 38, 39, 40] :

  • American Cancer Society (ACS)
  • U.S. Preventive Services Task Force (USPSTF)
  • American College of Obstetricians and Gynecologists (ACOG)

The guidelines differ in their recommendations regarding breast self-examination and clinical breast examination, use of screening mammography in women 40-49 years old, age at which to discontinue screening mammography, and MRI mammography. All three guidelines recommend routine screening mammography in asymptomatic, average-risk women aged 50 to 74, but differ with regard to frequency of screening.

American Cancer Society screening guidelines

The ACS updated its guidelines for breast cancer screening in average-risk women in October 2015. At this time, the ACS is in the process of updating the breast cancer screening guidelines for women at high risk, which were last updated in 2007. Beginning in their early 20s, women should be told about the benefits and limitations of BSE. The ACS does not recommend clinical breast examination for breast cancer screening in average-risk women at any age.

ACS recommendations are as follows:

  • Women should begin regular screening mammography at age 45 years (strong recommendation)
  • Women aged 45-54 years should be screened annually (qualified recommendation)
  • Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation)
  • Women should have the opportunity to begin annual screening at 40-44 years  of age (qualified recommendation)
  • Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer (qualified recommendation)

The ACS recommends annual MRI screening along with mammography, based on evidence from nonrandomized screening trials and observational studies, in women with the following risk factors:

  • BRCA mutation
  • First-degree relative of BRCA carrier, but untested
  • Lifetime risk ∼20–25% or greater, as defined by BRCAPRO or other models that are largely dependent on family history

The ACS recommends annual MRI screening, based on expert consensus opinion that considers evidence of lifetime risk for breast cancer, in women with the following risk factors:

  • Radiation to chest between age 10 and 30 years
  • Li-Fraumeni syndrome or first-degree relatives with the syndrome
  • Cowden and Bannayan-Riley-Ruvalcaba syndromes or first-degree relatives with those syndromes

USPSTF screening guidelines

In 2016, the USPSTF released updated recommendations on breast cancer screening, but did not update its 2009 recommendations for breast examination. In its 2016 statement, the USPSTF encouraged patients to be aware of changes in their bodies and discussing these changes with clinicians.

The 2009 breast examination recommendations are as follows:

  • No requirement for clinicians to teach women how to perform BSE (Grade D recommendation)
  • Insufficient current evidence to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older

The 2016 screening mammography recommendations are as follows:

  • No requirement for routine screening mammography in women aged 40 to 49 years (Grade C recommendation); the decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take into account patient context, including the patient's values regarding specific benefits and harms
  • Biennial screening mammography for women between the ages of 50 and 74 years (Grade B recommendation)
  • Insufficient current evidence to assess the additional benefits and harms of screening mammography in women 75 years or older
  • Insufficient current evidence to assess the additional benefits and harms of digital breast tomosynthesis (DBT) as a primary screening method for breast cancer
  • Insufficient current evidence to assess the additional benefits and harms of adjunctive screening for breast cancer using breast ultrasonography, magnetic resonance imaging, DBT, or other methods in women identified to have dense breasts on an otherwise negative screening mammogram

ACOG screening guidelines

The ACOG released its current guidelines in 2011.

Breast self-awareness should be encouraged and can include breast self-examination; women should report any changes in their breasts to their health care providers

  • For women aged 20–39 years, clinical breast examinations are recommended every 1–3 years.
  • For women aged 40 years and older, clinical breast examination should be performed annually

Women should be educated on the predictive value of screening mammography and the potential for false-positive results and false-negative results; women should be informed of the potential for additional imaging or biopsies that may be recommended based on screening results

  • Women aged 40 years and older be offered screening mammography annually
  • Biennial screening may be a more appropriate or acceptable strategy to some women, and recommends the screening strategy should therefore be determined based on the patient's individual risk and values.
  • Breast magnetic resonance imaging (MRI) is not recommended for screening women at average risk of developing breast cancer
  • Women who are estimated to have a lifetime risk of breast cancer of 20% or greater, based on risk models that rely largely on family history (such as BRCAPRO, BODACEA, or Claus), but who are either untested or test negative for BRCA gene mutations, can be offered enhanced screening
  • For women who test positive for BRCA1 and BRCA2 mutations, enhanced screening should be recommended and risk reduction methods discussed