Clinical Preventive Service Recommendation

Breast Cancer

Breast Cancer, Mammography, Before age 50

Grade: C recommendation

The decision to start screening mammography in women prior to age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years. (2016)

  • 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.
  • 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 “over diagnosis”). Beginning mammography screening at a younger age and screening more frequently may increase the risk for over diagnosis and subsequent overtreatment.
  • 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.


Grade Definition(www.uspreventiveservicestaskforce.org)

Clinical Considerations(www.uspreventiveservicestaskforce.org)

Breast Cancer, Mammography, Women 50 and 74

Grade B recommendation

The AAFP recommends biennial screening mammography for women aged 50 to 74 years. (2016)


Grade Definition(www.uspreventiveservicestaskforce.org)

Clinical Considerations(www.uspreventiveservicestaskforce.org)

Breast Cancer, Mammography, Women 75 years and older

Grade I recommendation

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women aged 75 years or older. (2016)

Grade Definition(www.uspreventiveservicestaskforce.org)

Clinical Considerations(www.uspreventiveservicestaskforce.org)

Breast Cancer, Self BSE

Grade D recommendation

Family physicians should discuss with each woman the potential benefits and harms of breast cancer screening tests and develop a plan for early detection of breast cancer that minimizes potential harms. These discussions should include the evidence regarding each screening test, the risk of breast cancer, and individual patient preferences. The recommendations below are based on current best evidence as summarized by the United States Preventive Services Task Force (USPSTF) and can help to guide physicians and patients. These recommendations are intended to apply to women who are not at increased risk of developing breast cancer and only apply to routine screening procedures.

The AAFP recommends against clinicians teaching women Breast Self Examination (BSE). (2009)

Grade Definition(www.uspreventiveservicestaskforce.org)

Clinical Considerations(www.uspreventiveservicestaskforce.org)

Breast Cancer, Clinical Breast Examination (CBE)

Grade I recommendation

Family physicians should discuss with each woman the potential benefits and harms of breast cancer screening tests and develop a plan for early detection of breast cancer that minimizes potential harms. These discussions should include the evidence regarding each screening test, the risk of breast cancer, and individual patient preferences. The recommendations below are based on current best evidence as summarized by the United States Preventive Services Task Force (USPSTF) and can help to guide physicians and patients. These recommendations are intended to apply to women who are not at increased risk of developing breast cancer and only apply to routine screening procedures.

The AAFP concludes that the current evidence is insufficientto assess the benefits and harms of clinical breast examination (CBE) for women aged 40 years and older. (2009)

Grade Definition(www.uspreventiveservicestaskforce.org)

Clinical Considerations(www.uspreventiveservicestaskforce.org)

Digital Breast Tomosynthesis (DBT), All Women

Grade I recommendation

The AAFP concludes that the current evidence is insufficient to assess the benefits and harms of digital breast tomosynthesis (DBT) as a primary screening method for breast cancer. (2016)

Grade Definition(www.uspreventiveservicestaskforce.org)

Clinical Considerations(www.uspreventiveservicestaskforce.org)

Screening Women with Dense Breasts

Grade I recommendation

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of adjunctive screening for breast cancer using breast ultrasonography, magnetic resonance imaging (MRI), DBT, or other methods in women identified to have dense breasts on an otherwise negative screening mammogram. (2016)

Grade Definition(www.uspreventiveservicestaskforce.org)

Clinical Considerations(www.uspreventiveservicestaskforce.org)

Breast Cancer, Prevention Medication

Grade: B recommendation

The AAFP recommends that clinicians engage in shared, informed decision making with women who are at increased risk for breast cancer about medications to reduce their risk. For women who are at increased risk for breast cancer and at low risk for adverse medication effects, clinicians should offer to prescribe risk-reducing medications such as tamoxifen or raloxifene. (2013)

Grade Definition(www.uspreventiveservicestaskforce.org)

Clinical Considerations(www.uspreventiveservicestaskforce.org)

Breast Cancer, Prevention Medication

Grade: D recommendation

The AAFP recommends against the routine use of medications, such as tamoxifen or raloxifene, for risk reduction of primary breast cancer in women who are not at increased risk for breast cancer. (2013)

Grade Definition(www.uspreventiveservicestaskforce.org)

Clinical Considerations(www.uspreventiveservicestaskforce.org)

Breast Cancer/BRCA Mutation Testing

Grade: B recommendation

The AAFP recommends that primary care providers screen women who have family members with breast, ovarian, tubal, or peritoneal cancer with one of several screening tools designed to identify a family history that may be associated with an increased risk for potentially harmful mutations in breast cancer susceptibility genes (BRCA1 or BRCA2). Women with positive screening results should receive genetic counseling and, if indicated after counseling, BRCA testing. (2013)


Grade Definition(www.uspreventiveservicestaskforce.org)

Clinical Consideration(www.uspreventiveservicestaskforce.org)

Breast Cancer/BRCA Mutation Testing

Grade: D recommendation

The AAFP recommends against routine genetic counseling or BRCA testing for women whose family history is not associated with an increased risk for potentially harmful mutations in the BRCA1 or BRCA2 genes. (2013)

Grade Definition(www.uspreventiveservicestaskforce.org)

Clinical Consideration(www.uspreventiveservicestaskforce.org)

 


These recommendations are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute for the individual judgment brought to each clinical situation by the patient's family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These recommendations are only one element in the complex process of improving the health of America. To be effective, the recommendations must be implemented.