Breast Cancer Screening Guidelines Summary
Clinical Practice Brief
Among the multiple published professional breast cancer screening guidelines, three commonly used guidelines are summarized here: the American Cancer Society (ACS), American College of Obstetricians and Gynecologists (ACOG) and United States Preventive Services Task Force (USPSTF) guidelines. Only ACS provided breast cancer screening guidelines for women at higher-than-average breast cancer risk. The National Cancer Institute has developed an online interactive Breast Cancer Risk Assessment Tool to help estimate a woman’s risk of developing breast cancer.
American Cancer Society (ACS) 2015 Breast Cancer Screening Guidelines Summary
Women at Average Risk
- Ages 40 to 44: Women should be offered the choice to start annual mammograms if they wish. The risks and benefits should be considered.
- Ages 45 to 54: Annual mammograms are recommended.
- Ages 55 and older: Mammograms every two years are recommended. Women should be offered the choice of annual screening is they wish to have more frequent screening. Screening should continue as long as the woman is expected to live 10 years or longer.
- All women should be: familiar with the known benefits, limitations and potential harms associated with breast cancer screening (see discussion below on benefits and harms of screening); be familiar with how their breasts normally look and feel; and report any changes to their health care provider.
- Clinical Breast Exam and Breast Self Exam: Not currently recommended because research has not shown a clear benefit.
Women at Higher Than Average Risk
According to the ACS, women with a personal history of breast cancer, women with a family history of breast cancer, women with a genetic mutation known to increase risk of breast cancer (such as BRCA) and women who had radiation therapy to the chest before the age of 30 are at higher risk for breast cancer, not average risk.
Women with any of the following risk factors should have an MRI and a mammogram every year:
- Lifetime risk of breast cancer of about 20% to 25% or higher, according to risk assessment tools based on family history, such as the BRCAPRO.
- First-degree relative (FDR), such as a parent, sibling or child, with a BRCA1 or BRCA2 mutation.
- Had radiation therapy to their chest between the ages of 10 and 30 years.
- Have Li-Fraumeni syndrome, Cowden syndrome or Bannayan-Riley-Ruvalcaba syndrome or have FDRs with one of these syndromes.
American College of Obstetricians and Gynecologists (ACOG)
Women at Average Risk
- Ages 19 and Older: Clinical Breast Exam every year for women.
- Ages 40 Years and Older: Screening mammography every year.
- Breast Self-Awareness has the potential to detect palpable breast cancer and can be recommended.
USPSTF 2016 Breast Cancer Screening Guidelines Summary
These recommendations apply to asymptomatic women aged 40 years or older who do not have pre-existing breast cancer or a previously diagnosed high-risk breast lesion and who are not at high risk for breast cancer because of a known underlying genetic mutation (such as a BRCA1 or BRCA2 gene mutation or other familial breast cancer syndrome) or a history of chest radiation at a young age.
Women aged 40 to 49 years
- Women who place a higher value on the potential benefit of screening than the potential harms may choose to begin biennial screening between ages 40 to 49.
- Women with a parent, sibling or child with breast cancer are at higher risk for breast cancer and thus may benefit more than average-risk women from beginning screening in their 40s.
- Benefits: For women who are at average risk for breast cancer, most of the benefit of mammography results from biennial screening during ages 50 to 74 years. Of all of the age groups, women aged 60 to 69 years are most likely to avoid breast cancer death through mammography screening. While screening mammography in women aged 40 to 49 years may reduce the risk for breast cancer death, the number of deaths averted is smaller than that in older women and the number of false-positive results and unnecessary biopsies is larger. The balance of benefits and harms is likely to improve as women move from their early to late 40s.
- Harms: In addition to false-positive results and unnecessary biopsies, all women undergoing regular screening mammography are at risk for the diagnosis and treatment of noninvasive and invasive breast cancer that would otherwise not have become a threat to their health, or even apparent, during their lifetime (known as “overdiagnosis”). Beginning mammography screening at a younger age and screening more frequently may increase the risk for overdiagnosis and subsequent overtreatment.
Women aged 50 to 74 years
- Screening mammograms every two years.
Women aged 75 years or older
- Insufficient evidence to assess the benefits and harms of screening mammography for women aged 75 and older.
Women with dense breasts
- Insufficient evidence is present to assess the balance of 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.
Breast Cancer Screening Recommendations Comparison Table
| Mammograms | CBE | BSE | Breast Awareness | |
| ACS | 40 to 44: Offer women a choice to start screening 45 to 54: Annual mammograms 55 and Older: Mammograms every two years | Not currently recommended | Not currently recommended | Recommended |
| ACOG | 40 and older: Annual mammograms | 19 and Older: Annual CBE | Not addressed | Recommended |
| USPSTF | 40 to 49: Women may choose to start mammograms every two years 50 to 74: Mammograms every two years 75 and older: Not recommended | Not addressed | Not addressed | Not addressed |
References
American College of Obstetricians and Gynecologists (2015). Breast Cancer Screening Recommendations.
American Cancer Society. (2015). Breast Cancer Prevention and Early Detection. Entire article.
Screening guidelines summary
Oeffinger, K. et al. (2015). Breast Cancer Screening for Women at Average Risk. 2015 Guideline Update from the American Cancer Society JAMA; 14(15) 1599-1614.
This Practice Brief was developed by the Practice Committee of the American Association of Nurse Practitioners®. Last updated in 2016.
Karen Greco, PhD, RN, ANP-BC, FAANP
Brian Buchner, DNP, RN, ACNP, FAANP
Oralea Pittman, DNP, FNP-BC, FAANP
Robin Arends, DNP, CNP, FNP-BC, FAANP
Heather Carlisle, PhD, DNP, RN, FNP-BC, AGACNP-BC