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. However, most organizations agree that women should work with their healthcare provider to assess their personal risk of developing breast cancer and to determine what is best for them. 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 College of Obstetricians and Gynecologists (ACOG) recommends a breast exam by a health professional every 1 to 3 years as part of a regular health exam.
- Breast self-exams are an option for women starting in their 20s, according to ACOG, 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
- ACOG says that, 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, according to ACOG; women should report any changes they feel in their breasts to their healthcare provider.
- ACOG and the American Medical Association (AMA) recommend that women be offered a mammogram annually starting at age 40.
- The American Cancer Society (ACS) says that women aged 40-44 should be offered the choice to begin breast cancer screening with mammograms; women aged 45-54 are recommended to have a mammogram every year.
- 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 (ACP) 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 recommends that women at high lifetime risk be screened with magnetic resonance imaging (MRI) in addition to mammography annually beginning at age 30 and continuing as long as they are in good health.
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
(2014 October 29). American Cancer Society Guidelines for the Early Detection of Cancer. American Cancer Society. Available online at http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer. Accessed on 4/1/15.
Smith, R. et al. (2015 January 8). Cancer screening in the United States, 2015: A review of current American Cancer Society guidelines and current issues in cancer screening. CA: A Cancer Journal for Clinicians. Available online at http://onlinelibrary.wiley.com/doi/10.3322/caac.21261/full. Accessed on 4/1/15.
Swart, R. et al. (2014 April 16). Breast Cancer Screening. Medscape. Available online at http://emedicine.medscape.com/article/1945498-overview. Accessed on 4/1/15.
(2014 December). Final Recommendation Statement, Breast Cancer: Screening, 2009. U.S. Preventative Services Task Force. Available online at http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/breast-cancer-screening. Accessed on 4/1/15.
Mayo Clinic Staff (20 November 2014). Breast cancer, risk factors. Mayo Clinic. Available online at http://www.mayoclinic.org/diseases-conditions/breast-cancer/basics/risk-factors/con-20029275. Accessed on 4/8/15.
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. Accessed on 4/8/15.
(26 February 2015, Revised). What are the risk factors for breast cancer? American Cancer Society. Available online at http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-risk-factors?sitearea=. Accessed on 4/8/15.
American Cancer Society. American Cancer Society recommendations for early breast cancer detection in women without breast symptoms. Available online at http://www.cancer.org/cancer/breastcancer/moreinformation/breastcancerearlydetection/breast-cancer-early-detection-acs-recs. Accessed November 2015.
Kevin C. Oeffinger, MD et al. Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society. JAMA. 2015;314(15):1599-1614. doi:10.1001/jama.2015.12783. Available online at http://jama.jamanetwork.com/article.aspx?articleid=2463262. Accessed November 2015.