Appendix F: Screening for Breast Cancer

Guide to Clinical Preventive Services, 2012

Screening for Breast Cancer

Clinical Summary of 2002 U.S. Preventive Services Task Force Recommendation*

PopulationWomen ages 40 years and older
Screening TestMammography, with or without clinical breast examinationClinical breast examination aloneBreast self-examination alone
RecommendationScreen every 1 to 2 years.
Grade: B
No recommendation.
Grade: I (Insufficient Evidence)
No recommendation.
Grade: I (Insufficient Evidence)
Risk AssessmentWomen 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 RecommendationsUSPSTF 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.
Current as of February 2013
Internet Citation: Appendix F: Screening for Breast Cancer: Guide to Clinical Preventive Services, 2012. February 2013. Agency for Healthcare Research and Quality, Rockville, MD. https://archive.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide2012/appendix-f.html