Breast Cancer Risk Assessment and Screening in Average-Risk Women
Publication Date: July 1, 2017
Last Updated: March 14, 2022
Recommendations
Women at average risk of breast cancer should be offered screening mammography starting at age 40 years. Women at average risk of breast cancer should initiate screening mammography no earlier than age 40 years. If they have not initiated screening in their 40s, they should begin screening mammography by no later than age 50 years. The decision about the age to begin mammography screening should be made through a shared decision- making process. This discussion should include information about the potential benefits and harms. (A)
574
Women at average risk of breast cancer should have screening mammography every 1 or 2 years based on an informed, shared decision-making process that includes a discussion of the benefits and harms of annual and biennial screening and incorporates patient values and preferences. Biennial screening mammography, particularly after age 55 years, is a reasonable option to reduce the frequency of harms, as long as patient counseling includes a discussion that with decreased screening comes some reduction in benefits. (A)
574
Women at average risk of breast cancer should continue screening mammography until at least age 75 years. (A)
574
Health care providers periodically should assess breast cancer risk by reviewing the patient’s history. (B)
574
Women with a potentially increased risk of breast cancer based on initial history should have further risk assessment. (B)
574
Breast self-examination is not recommended in average-risk women because there is a risk of harm from false-positive test results and a lack of evidence of benefit. (B)
574
Screening clinical breast examination may be offered to asymptomatic, average-risk women in the context of an informed, shared decision-making approach that recognizes the uncertainty of additional benefits and the possibility of adverse consequences of clinical breast examination beyond screening mammography. If performed for screening, intervals of every 1–3 years for women aged 25–39 years and annually for women aged 40 years and older are reasonable. The clinical breast examination continues to be a recommended part of evaluation of high-risk women and women with symptoms. (C)
574
Average-risk women should be counseled about breast self-awareness and encouraged to notify their health care provider if they experience a change. Breast self-awareness is defined as a woman’s awareness of the normal appearance and feel of her breasts. (C)
574
Age alone should not be the basis to continue or discontinue screening. Beyond age 75 years, the decision to discontinue screening mammography should be based on a shared decision making process informed by the woman’s health status and longevity. (C)
574
Recommendation Grading
Overview
Title
Breast Cancer Risk Assessment and Screening in Average-Risk Women
Authoring Organization
American College of Obstetricians and Gynecologists
Publication Month/Year
July 1, 2017
Last Updated Month/Year
January 17, 2024
Supplemental Implementation Tools
Document Type
Consensus
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Adolescent, Adult, Older adult
Health Care Settings
Ambulatory
Intended Users
Physician, nurse midwife, nurse, genetics, nurse practitioner, physician assistant
Scope
Assessment and screening
Diseases/Conditions (MeSH)
D055088 - Early Detection of Cancer, D001943 - Breast Neoplasms
Keywords
breast cancer, breast cancer risk, breast cancer screening
Methodology
Number of Source Documents
55
Literature Search Start Date
January 1, 2000
Literature Search End Date
April 1, 2017