What are the Recommendations for Breast Cancer Screening?

Different health organizations recommend different approaches to breast cancer screening. Here’s a summary of the guidelines published by several respected organizations.

The U.S. Preventive Services Task Force (USPSTF)

The USPSTF, a volunteer panel of 16 physicians and researchers, provides the following recommendations for people who are at average risk for breast cancer:

According the USPSTF, there’s not enough evidence to recommend additional screenings for people with denser breast tissue if the mammogram doesn’t show any signs of possible cancer.

American Cancer Society

The American Cancer Society recommends a slightly different screening schedule, which continues the recommendation for annual screenings into the mid-50s:

Similar to the USPSTF, the American Cancer Society doesn’t have specific recommendations for people with denser breast tissue, due to lack of evidence to support additional screenings.

American College of Obstetrics and Gynecology (ACOG)

Physician members of ACOG emphasize shared decision-making between doctors and patients, along with counseling on the benefits and risks of various screening exams.

If you’re asymptomatic and have no risk factors other than dense breast tissue, ACOG doesn’t recommend alternative or additional testing other than mammography, unless required by state law.

According to the Centers for Disease Control and Prevention (CDC), you may have a higher risk of developing breast cancer if you:

• have a BRCA1 or BRCA2 gene mutation
• have denser breast tissue
• have a close relative (grandparent, parent, sibling, child, aunt, uncle, or first cousin) who has a BRCA1 or BRCA2 gene mutation
• had radiation treatment in your chest area when you were between 10 and 30 years old
• have a family history of cancer that raises your overall breast cancer risk
• have a close family history of certain rare disorders, including Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome

Talk with a doctor about your risk factors. You can also calculate your overall breast cancer risk using one of the CDC’s assessment tools.

If you have a higher than average breast cancer risk, the American Cancer Society recommends that you have a mammogram and a MRI scan every year, beginning at age 30, for as long as your health is good. It’s important to take a doctor’s advice into consideration as you decide when to begin yearly screenings.

According to the CDC, the National Comprehensive Cancer Network — a nonprofit group made up of 31 cancer centers — recommends that people with high risk begin annual mammograms and MRI scans between 25 and 40 years old, or at the earliest age when someone in their family was diagnosed with cancer.

Healthcare professionals can detect changes in your breast tissue, including early signs of possible cancer, with several different tests, including:

Clinical breast examination

In a clinical breast exam (CBE), a physician checks your breasts by hand to detect any palpable lumps or irregularities. However, according to a 2020 review, research isn’t clear about exactly how effective CBE is at preventing cancer deaths.

Some researchers, as in a 2016 study, point out that doctors may be able to detect some types of cancers through a CBE that might be missed by a mammogram. For some groups of people, though, CBE may only provide limited use as a diagnostic tool.

For other people, the CBE process can be unnerving, especially if there is a personal history of physical or sexual abuse, according to 2017 research. The feelings triggered by breast exams can even lead women to postpone or avoid screenings that could save their lives.

If you have experienced trauma or abuse that makes you feel vulnerable, powerless, or anxious about clinical breast examinations, you can talk with your healthcare professional about your concerns in advance.

It’s OK to ask for a different type of screening or to ask for an examination by someone of a particular gender. It’s also OK to have someone else present in the room during your exam.

Mammography

Mammography is the most widely accepted screening for breast cancer. It’s an X-ray photograph of your breasts, taken by a mammography machine and read by a radiologist. Mammograms are covered under most health insurance plans, including Medicare and Medicaid.

3-D mammography

This type of mammogram, also called breast tomosynthesis, provides a much clearer and more detailed image of your breast tissue.

The American Cancer Society reports that 3-D mammography can create a clearer picture than an ordinary mammogram, and it may be more effective at locating possible cancer. The 3-D tests may also make it less likely that you’ll be called back for follow-up images.

Ultrasound

Ultrasound uses sound waves to create a picture of the inside of your breast. It’s particularly good for telling the difference between solid lumps and fluid-filled lumps in your breast tissue.

During an ultrasound, a technician places some gel onto your breast and then moves a wand around the surface of your breast to record an image created by the sound waves. The process doesn’t hurt.

Magnetic resonance imaging (MRI) scans

A breast MRI uses magnetic energy and radio waves to create a detailed image of your breast tissue. An MRI can be especially useful if you have dense breast tissue.

During an MRI, you lie on a table that has hollow spaces for your breasts. The table eases into a large tube-shaped MRI machine. The scanning devices rotate around you. The scan is noisy, but it shouldn’t hurt.

If you’re uncomfortable in enclosed spaces an MRI may cause you some anxiety. If your doctor has asked for an MRI, let them know if you’re claustrophobic or nervous. They can discuss ways to help lower your anxiety. They may also prescribe a muscle relaxer or anti-anxiety medication before the test.

Mammograms usually take place at an imaging center or in a radiologist’s clinic. Here are some tips to help you prepare for a mammogram:

• If possible, try to have your mammograms done at the same center every time. That’s because it’s important for the radiologist to see how your breast tissue has changed over time. If you do need to go to a different center, have the old center send your old images to the new center.
• If you menstruate and experience tender breasts around your period, try to schedule your mammogram for a time that isn’t close to your period. That’s because mammograms involve compressing your breasts, so it’s usually easier if your breasts aren’t already tender.
• Most centers advise you not to wear powders, deodorants, creams, or lotions under your arms because it can make the images harder to read accurately.
• If you’re breastfeeding or you think you might be pregnant, tell your technician before the test.

When you arrive at the center, you’ll probably be given a gown to wear that opens in the front. When it’s time for your test, a technician will help you place your breast between two plates on the X-ray machine.

Your breasts will need to be as flat as possible so the machine can capture clear images. It’s typical for the process to feel tight and uncomfortable, but if it’s painful, it’s OK to tell the technician.

The technician will photograph one breast at a time, usually from two different angles. Each image takes just a few seconds, then the pressure is released. Depending on how many images are needed, the entire mammogram process could finish in about 20 minutes.

After your exam, the radiologist will speak with your healthcare provider about any findings. Your healthcare provider will talk with you about the results, usually within a few days. If you haven’t heard back from your doctor within a week, it’s within your rights to call and ask to speak with your doctor and go over the results.

If your radiologist or doctor notices an area of concern, you may need a second mammogram, called a diagnostic mammogram.

Your healthcare professional might also recommend some extra tests, such as ultrasounds, MRI scans, or biopsies. During a biopsy a doctor removes a bit of your breast tissue so it can be analyzed more closely.

These extra tests are not uncommon, and they don’t mean you have breast cancer. You could be called back because:

• An image isn’t clear enough to see your breast tissue.
• Your breast tissue is extra dense.
• Your doctor wants to look more closely at a change in your breast tissue.
• A calcification, cyst, or mast needs a closer look.

The vast majority of breast cancer screenings do not result in a cancer diagnosis.

Almost any medical procedure carries some risk, including breast cancer screenings. It’s important to consider the known risks as you decide when to begin screenings and how often you want to have them.

Radiation-related cancer risk

Exposure to radiation can cause changes to your cells, some of which could raise your risk of cancer. You should know that the radiation from a mammogram is very low.

It’s lower than an ordinary chest x-ray and is comparable, some experts say, to the amount of radiation you would be exposed to in your usual environment over a period of around 7 weeks.

A 2016 study that analyzed breast cancer incidence in 100,000 people between the ages of 50 and 74 found that mammography could have played a role in the development of breast cancer in between 0.7 percent and 1.6 percent of the cases.

If you’re at high risk for breast cancer, you and your doctor should talk about how regular mammograms could impact your risks.

Other risks

Breast cancer screenings can sometimes result in:

• false positive results
• over-diagnosis of breast tumors
• unnecessary biopsies of breast tissue

In general, health professionals agree that the benefits of regular breast cancer screenings, including early detection of cancer, far outweigh the risks of screening tests themselves.

Breast cancer screening can be used to help your doctor detect cancer when it’s in its earliest stages. Earlier stage cancer is often easier to treat than cancers treated at a later stage.

The most common way to screen for breast cancer is using mammography, but ultrasounds and MRI scans can also be effective tests.

Many cancer specialists recommend that women begin having annual mammograms at 40. When you reach your 50s, you may opt for a mammogram every other year.

When you decide to start having mammograms and when you decide to stop having them is something to talk about with a doctor, since individual risk factors vary from person to person.

There are some risks to having breast cancer screenings, but they’re generally considered quite small compared to the advantage of being able to find and treat breast cancer in its earliest stages.