Breast Cancer Screening: Common Questions and Answers

 

Breast cancer is the most common nonskin cancer in women and accounts for 30% of all new cancers in the United States. The highest incidence of breast cancer is in women 70 to 74 years of age. Numerous risk factors are associated with the development of breast cancer. A risk assessment tool can be used to determine individual risk and help guide screening decisions. The U.S. Preventive Services Task Force (USPSTF) and American Academy of Family Physicians (AAFP) recommend against teaching average-risk women to perform breast self-examinations. The USPSTF and AAFP recommend biennial screening mammography for average-risk women 50 to 74 years of age. However, there is no strong evidence supporting a net benefit of mammography screening in average-risk women 40 to 49 years of age; therefore, the USPSTF and AAFP recommend individualized decision-making in these women. For average-risk women 75 years and older, the USPSTF and AAFP conclude that there is insufficient evidence to recommend screening, but the American College of Obstetricians and Gynecologists and the American Cancer Society state that screening may continue depending on the woman's health status and life expectancy. Women at high risk of breast cancer may benefit from mammography starting at 30 years of age or earlier, with supplemental screening such as magnetic resonance imaging. Supplemental ultrasonography in women with dense breasts increases cancer detection but also false-positive results.

Breast cancer is the most common nonskin cancer in women and accounts for 30% of all new cancers in the United States.1 From 2001 to 2016, more than 2.3 million women in the United States were diagnosed with breast cancer.2 The incidence of breast cancer increases after 25 years of age, peaking between 70 and 74 years.2 Approximately one in eight women will develop invasive breast cancer (12.8% lifetime risk).1

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

The USPSTF and AAFP state that there is insufficient evidence regarding the benefits and harms of breast self-examination and therefore recommend against teaching patients to perform it. The ACS encourages breast self-awareness and recommends against breast self-examination because of a lack of evidence regarding improved outcomes.26,27,31

C

Consensus expert opinion; lack of evidence supporting breast self-examination

The USPSTF recommends biennial screening mammography for average-risk women 50 to 74 years of age; the AAFP supports this recommendation.26,29

B

Meta-analysis of eight randomized trials; other organizations recommend considering annual screening

The American College of Obstetricians and Gynecologists recommends that women 75 years and older be involved in shared decision-making for screening mammography that is based on health status and life expectancy. The ACS and National Comprehensive Cancer Network recommend screening after 75 years of age if life expectancy is at least 10 years, and the American College of Radiology recommends continued screening if life expectancy is at least five to seven years.3,30,31,33

C

Consensus expert opinion; the risks vs. benefits in this age group have not been well-studied


AAFP = American Academy of Family Physicians; ACS = American Cancer Society; USPSTF = U.S. Preventive Services Task Force.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

The Authors

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MUNEEZA KHAN, MD, FAAFP, is program director of the Saint Francis Family Medicine Residency Program, Memphis, Tenn. She is also chair of and an associate professor in the Department of Family Medicine at the University of Tennessee Health Science Center, Memphis....

ANNA CHOLLET, MD, MPH, is a core faculty member at the Saint Francis Family Medicine Residency Program. She is also an assistant professor in the Department of Family Medicine at the University of Tennessee Health Science Center.

Address correspondence to Muneeza Khan, MD, FAAFP, University of Tennessee Health Science Center, 1301 Primacy Pkwy., Memphis, TN 38119 (email: mkhan14@uthsc.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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