Recommended Screening Guidelines
There are many different sources of guidelines for breast cancer screening based on interpretations of scientific studies. Overall, the guidance varies by organization, and because there are a number of risk factors associated with breast cancer, primary health care providers tailor recommendations to each patient.
The timelines outlined below are based on recommendations from the U.S. Preventive Services Task Force (USPSTF), and are for women classified as average risk for developing breast cancer. While many organizations have developed evidence-based guidelines for breast cancer screenings, the USPSTF evaluations of preventive services determine whether or not health insurers must cover the service in full. The evaluations are based on what the USPSTF refers to as ‘levels of certainty.’
Levels of certainty are determined by calculating the “substantial net benefit” of the screening. The USPSTF will recommend a screening if the benefits outweigh the harms of the preventive service. If there is evidence that the service has no benefit, or that “the harms outweigh the benefits,” the taskforce recommends against it.
The USPSTF guidelines cover most routine screenings, such as mammograms and preventive exams, outlining specific data-driven recommendations for each method. Mammograms are among the most common screening procedures, but also come with some of the most significant downsides, such as false positives and biopsies. As such, mammogram recommendations are broken down by age in a way that differs from other screening procedures.
Mammogram Screening Guidelines
Women younger than 50: The USPSTF recommends mammograms be an individual choice based on possible benefits and harms of the preventive screening.
Women 40-49: Individual choice for biennial screening, which may reduce the mortality of breast cancer in this age group, but also increases false-positives, biopsies, and treatments.
Women 50-74: Recommended for biennial screening. Age is one of the largest risk factors for breast cancer and women of this age group are often good candidates for treatment, meaning the benefits outweigh the risks.
Women 75 and older: The USPSTF reports that there is insufficient evidence to assess the substantial net benefit of mammograms for this age bracket.
Other Screening Methods
Breast self-exam: The USPSTF does not recommend teaching breast self-examination techniques. While the USPSTF recognizes benefits of breast self-exams, they do not recommend clinicians instruct patients on BSEs. Evidence supports that teaching breast self-exam techniques has been shown to increase anxiety and unnecessary concern around breast changes that are often benign.
Clinical breast exam: The substantial net benefit of clinical breast exams, which can be performed by a primary care provider, is inconclusive. Although indirect evidence may support the benefits of clinical breast examination, the USPSTF notes "no standard approach or reporting standards are in place.”
BRCA or genetic screening: If a woman has a family member with cancer, genetic screening and counseling are recommended. However, the USPSTF recommends against routine counseling and BRCA screening for women without an increased risk for developing breast cancer.
As our understanding of breast cancer and options for screening and treatment evolve, so will the guidelines for preventive screening recommendations. The changes that the USPSTF implemented in 2015 involved recognizing an increased risk of developing breast cancer in correlation with a woman’s breast density, as well as identifying 3-D mammography as a screening procedure. In both cases, the USPSTF concluded that more research is needed before further screening recommendations can be made. Moving forward, we may see additional USPSTF guidelines proposed that account for these.
According to the USPSTF, age 40 is the advised time to talk with a primary health care provider about your risk factors, and all women should begin mammogram screenings at age 50. In the meantime, the USPSTF has recommended that additional studies be conducted on breast cancer preventive screenings and will continue to update their recommendations as new research comes to light and best practices are developed.
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