What are the NCCN guidelines on breast cancer screening?

Updated: Apr 10, 2019
  • Author: Erin V Newton, MD; Chief Editor: Marie Catherine Lee, MD, FACS  more...
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The NCCN on screening in average-risk women includes the following recommendations [8] :

  • Clinical breast examinations every 1-years from age 25-39, then annually from age 40 on
  • Begin annual screening mammography at age 40 years.
  • Consider tomosynthesis (three-dimensional mammography)

NCCN guidelines provide four separate sets of recommendations for women at increased risk, on the basis of personal or family history, These include earlier initiation of mammography, in some cases, and consideration or recommendation of annual MRI. Additional considerations include the following:

  • An upper age limit for screening is not yet established. Consider severe comorbid conditions limiting life expectancy (eg, ≤10 years) and whether therapeutic interventions are planned.

  • For women with heterogeneous dense breasts and dense breast tissue, recommend counseling on the risks and benefits of supplemental screening.

  • Dense breasts limit the sensitivity of mammography and are associated with an increased risk for breast cancer.

  • Full-field digital mammography appears to benefit young women and women with dense breasts.

  • Multiple studies show that tomosynthesis can decrease callback rates and appears to improve cancer detection. Most studies used double the dose of radiation, but the radiation dose can be minimized by using synthesized 2-D reconstruction.

  • Hand-held or automated ultrasound can increase cancer detection, but may increase recall and benign breast biopsies.

  • Current evidence does not support the routine use of molecular imaging (eg, breast-specific gamma imaging, sestamibi scan, or positron emission mammography) as screening procedures, but emerging evidence suggests that these tests may improve detection of early breast cancers in women with mammographically dense breasts. However, the whole-body effective radiation dose with these tests is between 20 –30 times higher than that of mammography.

  • Current evidence does not support the routine use of thermography or ductal lavage as screening procedures.

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