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Breast Cancer Screening: Who, When, and How?

New USPSTF guidelines narrow the proposed age range for screening mammography and recommend biennial screening.

In 2002, the U.S. Preventive Services Task Force (USPSTF) recommended screening mammography every 1 to 2 years for all women 40 or older. In a 2009 update, the task force has revised its guidelines based on: 1) a systematic review of the benefits and harms of screening; and 2) statistical modeling to estimate outcomes associated with annual versus biennial screening that begins and ends at different ages.

The USPSTF now recommends against routine screening of younger women (age range, 40–49). Decisions about screening women younger than 50 should be individualized. C recommendation (The USPSTF recommends against routinely providing the service; the grading system can be accessed on the USPSTF website.) The task force recommends biennial screening mammography for all middle-aged women (age range, 50–74). B recommendation (The USPSTF recommends the service.) However, current evidence is insufficient to assess the benefits and harms of screening mammography in older women (age, 75 [I statement]).

The task force also found that current evidence is insufficient to assess the benefits and risks of clinical breast examination that is performed in addition to mammography in women age 40 (I statement), as well as to assess benefits and harms of digital mammography or magnetic resonance imaging compared with film mammography. (I statement) Teaching women to perform breast self-examination is now discouraged. D recommendation (The USPSTF recommends against the service.)

Comment: Understandably, breast cancer screening generates anxiety among many women. Because these new guidelines specify that mammography be performed in fewer women — and less often — reactions among women likely will be characterized by confusion and even outrage. Several other U.S. organizations still endorse annual screening beginning at age 40. Although this discrepancy will add to the confusion, it will also enable clinicians and patients to choose the guideline that is most consistent with their preconceptions and preferences.

— Andrew M. Kaunitz, MD

Published in Journal Watch Women's Health November 16, 2009

Citation(s):

U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2009 Nov 17; 151:716.

• Original article (Subscription may be required)
• Medline abstract (Free)

Mandelblatt JS et al. for the Breast Cancer Working Group of the Cancer Intervention and Surveillance Modeling Network (CISNET). Effects of mammography screening under different screening schedules: Model estimates of potential benefits and harms. Ann Intern Med 2009 Nov 17; 151:738.

• Original article (Subscription may be required)
• Medline abstract (Free)

Kerlikowske K. Evidence-based breast cancer prevention: The importance of individual risk. Ann Intern Med 2009 Nov 17; 151:750.

• Original article (Subscription may be required)
• Medline abstract (Free)

Reader Remarks:

Read all Reader Remarks on this article

• in response to guidelines re: breast cancer prevention
  Rebecca M. Keaton, Gadsden Co. Health Dept. Quincy, FL, 17 Nov 2009 1:27 PM EST
  How many women find "lumps" and then see a provider and the lump is cancerous? And how many providers find... [more]
• Reassurance is vital.
  Mahamood Syed Basharuthulla,MD,FACP,FRCP(G) FRCPI., Sagar Hospital Bangalore-India, 18 Nov 2009 12:31 AM EST
  Perhaps the task force is right in their recommendation, but still women need reassurance. Medical practioners should not deny clinical... [more]
• Recommending No Breast Cancer Screening or Self Examination
  Robert B Greiwe, 18 Nov 2009 7:35 PM EST
  .....this article from the USPSTF is plain stupid........cancer screening and self examination has allowed numerous individuals I know to detect... [more]
• RECOMMENDING NO BREAST SCREENING OR SELF EXAMINATION
  Rev. Dr. Consuelo "Dr. Charity" Jackson, D.D., Christians by Design Images Ministries, Health/Welfare Advocate, Atlanta, Ga, 19 Nov 2009 2:58 PM EST
  I am in agreement with Robert Greiwe, that it does not make sense to stop anything that has been a... [more]
• A Survivor and Provider's View
  S.A. Pierson FNP-C, 19 Nov 2009 10:49 PM EST
  I was diagnosed with invasive ductal carcinoma at the age of 43 after a routine mammogram. I would have had... [more]
• A 10 year+ survivor
  L.D. Kelly, RN BSN, 23 Nov 2009 11:52 AM EST
  I too was diagnosed with ductal carcinoma at age 41 after a clinical breast exam and mammogram. The lump was... [more]
• A Hollistic Appraoch is Required
  Dr. SHASHI SIGDEL, 28 Nov 2009 12:54 PM EST
  The Task Force has shared its finding and it deserves thanks for this effort. But as Physicians, we know that... [more]
• Why no oncologist on the USPSTF board?
  Kristine E Sulzberger, 3 Dec 2009 8:39 PM EST
  I find it curious--actually, irresponsible--that the participants in this decision did not include even one oncologist. How can an entity... [more]
• regarding the New USPSTF guidelines
  fatina m Al tahan, king abdulaziz medical city- National Guard \ KSA, 5 Dec 2009 12:56 PM EST
  i don't agree with this guideline totally. i write from my 12 years expirience in Breast imaging in saudi arabia... [more]
• Re: time of diagnosis
  Nancy Mellow, solo private practice, 15 Dec 2009 11:32 PM EST
  Even though cancer mortality might be unchanged if an early stage breast cancer is diagnosed one year later, it seems... [more]
• breast cancer screening
  Richard R Ganz, 20 Jan 2010 4:16 PM EST
  None of the testimonies from survivors indicates an awareness of the estimates of 30-70% overdiagnosis (by a Danish statistician). If... [more]