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. 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: Ages 50 to 74 without known risk factors
- The American College of Obstetricians and Gynecologists (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, says ACOG; women should report any changes they feel in their breasts to their healthcare provider.
- ACOG and the American Medical Association (AMA) recommend annual screening with a mammogram.
- The American Cancer Society (ACS) recommends women aged 45-54 have an annual mammogram; women aged 55 and older have the option to switch to mammograms every two years or continue with annual screening.
- The U.S. Preventive Services Task Force (USPSTF) and the American College of Physicians (ACP) recommend that women ages 50 to 74 should have a routine screening mammogram every two years.
Recommendations: Over Age 74 without known risk factors
- According to ACOG, women in this age group may choose to continue having breast exams by health professionals, performing breast self-exams, and/or having mammograms yearly.
- ACS says that mammography screening should continue as long as a woman is in good health and she is expected to live for 10 years or longer.
- The USPSTF has stated that current evidence is insufficient to determine whether there are additional benefits and harms from screening mammography in women 75 years or older and makes no specific recommendation for this age group.
- ACP recommends against screening women 75 years and older.
Family history and genetics can contribute to a high lifetime risk. Other risk factors for breast cancer include 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.
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
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. 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 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.
(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.
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.