What are the ACS guidelines on breast cancer screening?

Updated: Oct 17, 2016
  • Author: Nagwa Dongola, MD, FRCR; Chief Editor: Peter Eby, MD  more...
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Answer

The ACS updated its guidelines for breast cancer screening in average-risk women in October 2015. At this time, the ACS is in the process of updating the breast cancer screening guidelines for women at high risk, which were last updated in 2007. Beginning in their early 20s, women should be told about the benefits and limitations of BSE. The ACS does not recommend clinical breast examination for breast cancer screening in average-risk women at any age.

ACS recommendations are as follows:

  • Women should begin regular screening mammography at age 45 years (strong recommendation)
  • Women aged 45-54 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 have the opportunity to begin annual screening at 40-44 years  of age (qualified recommendation)
  • Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer (qualified recommendation)

The ACS recommends annual MRI screening along with mammography, based on evidence from nonrandomized screening trials and observational studies, in women with the following risk factors:

  • BRCA mutation

  • First-degree relative of BRCA carrier, but untested

  • Lifetime risk ∼20–25% or greater, as defined by BRCAPRO or other models that are largely dependent on family history

The ACS recommends annual MRI screening, based on expert consensus opinion that considers evidence of lifetime risk for breast cancer, in women with the following risk factors:

  • Radiation to chest between age 10 and 30 years

  • Li-Fraumeni syndrome or first-degree relatives with the syndrome

  • Cowden and Bannayan-Riley-Ruvalcaba syndromes or first-degree relatives with those syndromes


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