What are the Recommendations for Breast Cancer Screening?

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Having your breasts regularly checked for signs of cancer is an important part of taking care of your health. That’s because many breast cancer screening tests can detect cancer long before you might notice symptoms on your own.

Breast cancer screening tests can detect small changes in your breast tissue from year to year. If a screening test identifies a problem, your healthcare team can explore the area in greater depth to see whether the changes are from cancer or something else.

When breast cancer is detected and treated in its earliest stages, treatment is generally more successful.

The American Cancer Society reports that the 5-year relative survival rate for people whose breast cancer was detected in an early stage is .

When breast cancer is detected at a later stage, treatment is often more involved, and the 5-year relative survival rate is lower. Keep in mind that these statistics, from 2010 to 2016 data, represent a general trend, and your situation may have a more positive outlook.

Read on to learn more about breast cancer screening recommendations and procedures.

What are the breast cancer screening guidelines?

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

Age Recommendations
40–49 individual choice — screening may occur once every 2 years or you may wait until you’re 50
50–74 mammogram once every 2 years
75+ no recommendations for or against, so talk with your doctor to come up with a screening plan

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

Age Recommendations
40–44 individual choice
45–54 mammogram once per year
55+ mammogram every 1–2 years, as long as you’re in good health with a life expectancy of 10 years or longer

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

Age Recommendations
40–49 individual choice based on conversations with your doctor — you may choose to have a yearly clinical exam and mammogram, or you may have mammograms every 2 years
50–74 mammogram every 1–2 years
75+ work with your doctor to decide when to stop screening, based on general health and life expectancy

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

What about people at higher risk for breast cancer?

According to the , you may have a higher risk of developing breast cancer if you:

  • have a gene mutation
  • have
  • 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 , 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 .

If you have a higher than average breast cancer risk, the 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 , 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.

What procedures are used for breast cancer screening?

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 , research isn’t clear about exactly how effective CBE is at preventing cancer deaths.

Some researchers, as in a , 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 . 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

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 and Medicaid.

3-D mammography

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

The 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

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 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 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.

What to expect when you have a mammogram screening exam

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 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.

What happens if the results aren’t as expected?

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 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.

Are there any risks associated with breast cancer screening?

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, , to the amount of radiation you would be exposed to in your usual environment over a period of around 7 weeks.

A 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.

The bottom line

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.