Appendix F: Screening for Breast Cancer

Guide to Clinical Preventive Services, 2014

Breast Cancer (2002 Recommendation)*

Title Screening for Breast Cancer (2002 Recommendation)
Population Women ages 40 years and older
Screening Test Mammography, with or without clinical breast examination Clinical breast examination alone Breast self-examination alone
Recommendation Screen every 1 to 2 years.
Grade: B
No recommendation.
Grade: I (Insufficient Evidence)
No recommendation.
Grade: I (Insufficient Evidence)
Risk Assessment Women who are at increased risk for breast cancer (e.g., those with a family history of breast cancer in a mother or sister, a previous breast biopsy revealing atypical hyperplasia, or first childbirth after age 30) are more likely to benefit from regular mammography than women at lower risk.
Screening Tests There is fair evidence that mammography screening every 12 to 33 months significantly reduces mortality from breast cancer. Evidence is strongest for women ages 50 to 69 years. For women ages 40 to 49 years, the evidence that screening mammography reduces mortality from breast cancer is weaker, and the absolute benefit of mammography is smaller, than it is for older women.

Clinicians should refer patients to mammography screening centers with proper accreditation and quality assurance standards to ensure accurate imaging and radiographic interpretation. Clinicians should adopt office systems to ensure timely and adequate follow-up of abnormal results.

Balance of Benefits and Harms The precise age at which the benefits from screening mammography justify the potential harms is a subjective judgment and should take into account patient preferences. Clinicians should inform women about the potential benefits (reduced chance of dying from breast cancer), potential harms (false-positive results, unnecessary biopsies), and limitations of the test that apply to women their age. The balance of benefits and potential harms of mammography improves with increasing age for women ages 40 to 70 years.

Clinicians who advise women to perform breast self-examination or who perform routine clinical breast examination to screen for breast cancer should understand that there is currently insufficient evidence to determine whether these practices affect breast cancer mortality, and that they are likely to increase the incidence of clinical assessments and biopsies.

Other Relevant USPSTF Recommendations USPSTF recommendations on screening for genetic susceptibility for breast cancer and chemoprevention of breast cancer are available at http://www.uspreventiveservicestaskforce.org.

*The U.S. Department of Health and Human Services, in implementing the Affordable Care Act, under the standard it sets out in revised Section 2713(a)(5) of the Public Health Service Act, utilizes the 2002 recommendation on breast cancer screening of the U.S. Preventive Services Task Force.

For a summary of the evidence systematically reviewed in making this recommendation, the full recommendation statement, and supporting documents, please go to
http://www.uspreventiveservicestaskforce.org/.

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Page last reviewed June 2014
Internet Citation: Appendix F: Screening for Breast Cancer: Guide to Clinical Preventive Services, 2014. June 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/appendix-f.html