available guidelines for breast cancer screening. risks and benefits of mammography.

2. Breast cancer is the most common cancer in
women worldwide (1).
Breast cancer continues to rank second, after lung
cancer, as a cause of cancer death in women in the
United States, and it is a leading cause of
premature mortality for women (1).

3. Screening mammograms can be used to check for breast
cancer in women with no signs or symptoms of the
disease.
Mammography can be used to screen women in order to
reduce their risk of death from breast cancer.
In RCTs, for women aged 40-74 years, screening with
mammography has been associated with a 15% to 20%
relative reduction in mortality from breast cancer (3).
This benefit is age dependent and the strongest evidence
for the greatest benefit is among women aged 60 to 69
years (2, 4).
High risk women (with a parent, sibling, or child with
breast cancer) may benefit more than average-risk
women from beginning screening in their 40s (4)

4. In addition to false-positive results and unnecessary
biopsies, screening mammography increases the risk for
diagnosis and treatment of noninvasive and invasive
breast cancer that would otherwise not have become a
threat to patients health, or even apparent, during their
lifetime (Overdiagnosis).
Screening at a younger age / screening more frequently
may increase the risk for overdiagnosis and subsequent
overtreatment.
Other harms include pain, and radiation exposure
Theoretically, annual mammograms in women aged 40 to

5. U.S. Preventive Services Task Force (USPSTF)
Women aged 50 to 74 years: biennial screening
mammography
Women aged 40 to 49 years:.
• Based on patient preference (Women who place a higher
value on the potential benefit than the potential harms)
• Women with a parent, sibling, or child with breast
cancer are at higher risk for breast cancer and thus may
benefit more than average-risk women from beginning
screening in their 40s.
Women aged 75 years or older: the current evidence is
insufficient to assess the balance of benefits and harms of
screening mammography in women aged 75 years or older.

6. American College of Obstetricians and Gynecologists
(ACOG)• For women at average risk, health care providers should
discuss the benefits and harms of Annual screening
mammography starting at age 40 years.
• Health care providers should work with patients to
determine the best screening strategy based on individual
risk and values. In some women, biennial screening may
be a more appropriate or acceptable strategy. Some
average-risk women may prefer biennial screening, which
maintains most of the benefits of screening while
decreasing both the frequency of screening and the
potential for additional testing, whereas other women may
prefer annual screening because it maximizes cancer
detection.
• The decision of when to start screening, the frequency of

7. American Cancer Society (ACS)
• Women with an average risk of breast cancer should undergo
regular screening mammography starting at age 45 years
(strong recommendation = benefits of adherence to the
intervention outweigh the undesirable effects).
• Women should have the opportunity to begin annual
screening between the ages of 40 and 44 years (qualified
recommendation = clear evidence of benefit but less
certainty on “balance of benefits/harms, or patients
preferences.
• Women aged 45 to 54 years should be screened annually
(qualified recommendation).
• Women 55 years and older should transition to biennial
screening or have the opportunity to continue screening
annually (qualified recommendation).
• Women should continue screening mammography as long as

8. American College of Radiology (ACR)
• Annual screening mammography for women starting at
age 40.
• Age 25-30 for BRCA 1 carriers & untested relatives of
BRCA carriers
• age 25-30 or 10 years earlier than the age of the affected
relative at diagnosis (whichever is later) for women with a
first-degree relative with premenopausal breast cancer or
for women with a lifetime risk of breast cancer ≥20% on
the basis of family history
There is no established age for women to stop screening.
Women should continue breast cancer mammography
screening as long as they are healthy and desire to remain

9. National Cancer Institute (NCI)
Start at age of 40 years and older, every 1-2 years

10. 1) Kevin C, Breast Cancer Screening for Women at Average Risk: 2015
Guideline Update from the American Cancer Society; JAMA. Author
manuscript; available in PMC 2016 Apr 14.
2) Bryan TJ, et al. Impact of an educational intervention on provider
knowledge, attitudes, and comfort level regarding counseling women
ages 40-49 about breast cancer screening. J Multidiscip Healthc. 2015
May 4;8:209-16.
3) https://www.cancer.gov/types/breast/hp/breast-screening-pdq
4)https://www.uspreventiveservicestaskforce.org/Page/Document/Rec
ommendationStatementFinal/breast-cancer-screening1