
This is a corrected version of the article that appeared in print.
Am Fam Physician. 2021;103(1):33-41
Patient information: See related handout on mammogram screening for breast cancer, written by the authors of this article.
Author disclosure: No relevant financial affiliations.
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.

Recommendation | Sponsoring organization |
---|---|
Do not routinely use breast magnetic resonance imaging for breast cancer screening in average-risk women. | Society of Surgical Oncology |
Do not perform screening mammography in asymptomatic patients with normal examination findings who have less than a five-year life expectancy. | American Society of Breast Surgeons – Benign Breast Disease |
Do not recommend screening for breast cancer if life expectancy is estimated to be less than 10 years. | Society for Post-Acute and Long-Term Care Medicine |
Do not recommend screening for breast, colorectal, prostate, or lung cancers without considering life expectancy and the risks of testing, overdiagnosis, and overtreatment. | American Geriatrics Society |
What Are the Risk Factors for Breast Cancer?

Factor | Risk of breast cancer (relative risk unless otherwise noted) |
---|---|
BRCA mutations by age group | |
20 to 29 years | BRCA1: 106, BRCA2: 46 |
30 to 39 years | BRCA1: 44, BRCA2: 38 |
40 to 49 years | BRCA1: 15, BRCA2: 13 |
50 to 59 years | BRCA1: 8.2, BRCA2: 9.8 |
60 to 69 years | BRCA1: 2.8, BRCA2: 2.1 |
History of chest radiotherapy | |
Overall | SIR = 21.9 |
Whole lung radiation | SIR = 43.6 |
Patient age | |
Age ≥ 65 years vs. < 65 years | > 4.0 |
Breast density | |
≥ 75% | 4.64 |
50% to 74% | 2.92 |
25% to 49% | 2.11 |
5% to 24% | 1.79 |
< 5% | 1.0 |
History of breast cancer | |
First-degree relative with breast cancer | HR = 1.61; OR = 1.64 |
Personal history of breast cancer | 1.42 |
Benign breast disease | |
Proliferative disease with atypia | 3.93 |
Proliferative disease without atypia | 1.76 |
Nonproliferative disease | 1.17 |
Age at menopause | |
45 to 49 years | 0.86 |
≥ 55 years | 1.12 |
Age at menarche | |
11 years | 1.09 |
15 years | 0.92 |
Reproductive history | |
Nulliparity | 1.0 |
First pregnancy at 35 years | 1.16 |
First pregnancy at < 30 years | 0.73 |
Hormone therapy | |
1 to 4 years of combined estrogen/progestin | 1.60 |
1 to 4 years of estrogen only | 1.17 |
5 to 14 years of combined estrogen/progestin | 2.08 |
5 to 14 years of estrogen only | 1.33 |
Other | |
Obesity (body mass index > 30 kg per m2) | 1.48 |
Moderate alcohol consumption | 1.1 |
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