New Breast Cancer Screening Guidelines: Start at Age 45

Annual screening mammography need only begin at age 45 for women who are at average risk of developing breast cancer, according to a study published in JAMA.

Researchers from New York, Washington, Massachusetts, Texas, California, Minnesota, Georgia, and Virginia sought to update the American Cancer Society (ACS) 2003 breast cancer screening guidelines for women who are at average risk for breast cancer.

The researchers performed a systematic review of the breast cancer screening literature and formulated recommendations based on the quality of the evidence and judgment (incorporating values and preferences) about the balance of benefits and harms.

The three key questions the researchers used were:

1. What are the relative benefits, limitations, and harms associated with mammography screening compared with no screening in average-risk women 40 years and older, and how do they vary by age, screening interval, and prior screening history?

2. Among average-risk women who are screened with mammography, what are the relative benefits, limitations, and harms associated with annual, biennial, triennial, or other screening interval, and how do they vary by age?

3. What are the benefits, limitations, and harms associated with clinical breast examination (CBE) among average-risk women 20 years and older compared with no CBE, and how do they vary by age, interval, and participation rates in mammography screening?[[{"type":"media","view_mode":"media_crop","fid":"42541","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_9651860278719","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4620","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 170px; width: 200px; float: right;","title":"©Sam 72/Shutterstock.com","typeof":"foaf:Image"}}]]

Two other key questions looked at the risk and benefits among women with an increased risk of breast cancer, related to screening.

Following the review, the American Cancer Society Guideline for Breast Cancer Screening was updated to reflect the findings:

• Women should undergo regular screening mammography starting at age 45

• Women age 45 to 54 should be screened annually

• Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually

• Women should have the opportunity to begin annual screening between the ages of 40 and 44

• Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer

• Clinical breast examination is not recommended for breast cancer screening among average-risk women at any age

"After careful examination of the burden of disease among women aged 40 to 54 years, the guideline development group (GDG) concluded that the lesser, but not insignificant, burden of disease for women aged 40 to 44 years and the higher cumulative risk of adverse outcomes no longer warranted a direct recommendation to begin screening at age 40 years," the authors wrote.

They emphasized that the guidelines are to help women and their doctors discuss the options given their individual risks, and that women be provided with the necessary information to make an informed decision.

The ACR and Society for Breast Imaging (SBI) continue to recommend that women get yearly mammograms starting at age 40.