Breast cancer is the second leading cause of cancer death in American women. About 2 out of 3 breast cancers are found in women 55 or older and 1 out of 8 are found in women younger than 45. Regular screening can help to detect tumors at an early stage when they are most treatable. Several methods are available for screening, including mammography, an imaging test that is especially effective at detecting breast cancer several years before symptoms develop.
The medical community recognizes the value of breast cancer screening and mammography, but there is no universal consensus on how often it should be done or when it should be started. Women should work with their healthcare provider to assess their personal risk of developing breast cancer and to determine how often screening should be done. Considerations can be given to the benefits of screening as well as the harms. While screening can detect cancer early when it is most treatable, it may also lead to false-positive results and unnecessary follow-up procedures, such as biopsies.
Recommendations: Women in their 30s without known risk factors
- The American Cancer Society (ACS) and the American College of Obstetricians and Gynecologists (ACOG) recommend a breast exam by a health professional at least every 3 years as part of a regular health exam.
- Breast self-exams are an option for women starting in their 20s, according to ACS, and women should report any changes they feel in their breasts to their healthcare provider.
- Mammograms are generally not recommended for women younger than 40 with no known risk factors.
Recommendations: Women in their 40s without known risk factors
- Starting at age 40, women should have a breast exam by a health professional yearly as part of their regular health exam.
- Breast self-exams are also an option; women should report any changes they feel in their breasts to their healthcare provider.
- ACS, ACOG and the American Medical Association recommend that women be offered a mammogram annually starting at age 40.
- The U.S. Preventive Services Task Force (USPSTF) says that for women aged 40-49, the decision when to start regular screening mammography should be an individual one, taking into consideration such factors as a woman's risk tolerance.
- The American College of Physicians says that women aged 40 to 49 years should discuss the benefits and harms of screening mammography with a health practitioner; if the choice is to undergo screening, have it done every 2 years.
Family history and genetics can contribute to a high lifetime risk. Other risk factors for breast cancer include, for example, a personal history of breast cancer, obesity, beginning your period at a younger age, having your first child after age 35, never giving birth, postmenopausal hormone therapy, beginning menopause at an older age, and alcohol consumption The American Cancer Society’s 2007 guidance recommends that women at high lifetime risk be screened with magnetic resonance imaging (MRI) in addition to mammography annually beginning at age 30.
Some of the important factors contributing to a high lifetime risk include:
- Carrying a mutated BRCA1 or BRCA2 gene or having a close relative with the gene
- Having had chest radiation at a young age (between 10 and 30 years old)
- Certain family histories, such as multiple close relatives with breast or ovarian cancer
If you suspect you are at an increased risk for breast cancer, you should consult your healthcare provider and consider developing an individualized screening program.
Sign up for the American Cancer Society's Breast Cancer Screening Reminder
American Cancer Society: What are the risk factors for breast cancer?
American Cancer Society: Can breast cancer be found early?
ACS: Clinical Breast Exam
ACS: Breast Awareness and Self Exam
National Cancer Institute: Breast Cancer Screening
Sources Used in Current Review
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Saslow, et al. (2007). American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography. CA: A Cancer Journal for Clinicians. Available online at http://www.penncancer.org/pdf/MR%20BreastGline.pdf through http://www.penncancer.org. Accessed on 4/8/15.
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