Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content +++ BREAST CANCER +++ Population ++ – Women. +++ Recommendations ++ Table Graphic Jump Location | Download (.pdf) | Print Consider screeninga Screen regularly Screening frequency Stop screening Include breast exam? USPSTF 2016 40–49 y 50–75 y Every 2 y Inconclusive data age >75 y Screen “with or without” ACS 2016 40–44 y ≥45 y Every year until 54 y, then every 1–2 y Life expectancy <10 y “Do not use” NCCN 2019 40–80 y Every year >80 y Yes ACP 2019 40–49 y 50–74 y Every 2 y ≥75 y or life expectancy <10 y “Should not use” ACOG 2017 40–49 y 50–75 y Every 1–2 y >75 y with shared decision making “May be offered” WHO 2014 40–49 only in well-resourced settings 50–75 y Every 2 y 75 y Only in low-resource settings a Each guideline within this category makes a statement supporting an assessment of risk, often relying heavily upon family history, and eliciting patient preference to guide a discussion of risks and benefits to determine whether to screen. +++ Sources ++ – http://www.cancer.org – Ann Intern Med. 2016;164:279. – Ann Intern Med. 2019;170:547. – CA Cancer J Clin. 2016;66:95. – JAMA. 2015;314:1599. – Obstet Gynecol. 2017;130:241. – https://www.who.int/cancer/publications/mammography_screening/en/ – www.nccn.org (Guidelines Version 1.2019). +++ Comments ++ Harm and benefit of mammography screening Benefits: Based on fair evidence, screening mammography in women age 40–70 y decreases breast cancer mortality. The benefit is higher in older women (reduction in risk of death in women age 40–49 y = 15%–20%, 25%–30% in women age ≥50 y) but still remains controversial. (BMJ. 2014;348:366) (Ann Intern Med. 2009;151:727) Harms: Based on solid evidence, screening mammography may lead to potential harm by overdiagnosis (indolent tumors that are not life threatening) and unnecessary biopsies for benign disease. It is estimated that 20%–25% of diagnosed breast cancers are indolent and unlikely to be clinically significant. (CA Cancer J Clin. 2012;62:5) (Ann Intern Med. 2012;156:491) Clinical breast exam does not improve breast cancer mortality (Br J Cancer. 2003;88:1047) and increases the rate of false-positive biopsies. (J Natl Cancer Inst. 2002;94:1445) Twenty-five percent of breast cancers diagnosed before age 40 y are attributable to BRCA1 or 2 mutations. The sensitivity of annual screening of young (age 30–49 y) high-risk women with magnetic resonance imaging (MRI) and mammography is superior to either alone, but MRI is associated with a significant increase in false positives. (Lancet. 2005;365:1769) (Lancet Oncol. 2011;378:1804) Computer-aided detection in screening mammography appears to reduce overall accuracy (by increasing false-positive rate), although it is more sensitive in women age <50 y with dense breasts. (N Engl J Med. 2007;356:1399) Digital mammography and film screen mammography have equal accuracy in women 50- to 79-y-old, but ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth