Recommendation Statement From USPSTF: Screening for Breast Cancer

US Preventive Services Task Force (USPSTF)

Disclosures

December 17, 2009

In This Article

Clinical Considerations

Patient Population Under Consideration

This recommendation statement applies to women 40 years or older who are not at increased risk for breast cancer by virtue of a known underlying genetic mutation or a history of chest radiation.

Assessment of Risk

Increasing age is the most important risk factor for breast cancer for most women. Women without known deleterious genetic mutations (such as BRCA1 or BRCA2) may still have other demographic, physical, or historical risk factors for breast cancer, but none conveys a clinically important absolute increased risk for cancer.

Screening Tests

In recent decades, the early detection of breast cancer has been accomplished by physical examination by a clinician (CBE), by a woman herself (BSE), or by mammography. Standardization of mammography practices enacted by the Mammography Quality Standards Act has led to improved mammography quality. Clinicians should refer patients to Mammography Quality Standards Act-certified facilities, a listing of which is available at http://www.fda.gov/cdrh/mammography/certified.html.

Screening Intervals

In trials that demonstrated the effectiveness of mammography in decreasing breast cancer mortality, screening was performed every 12-33 months. The evidence reviewed by the USPSTF indicates that a large proportion of the benefit of screening mammography is maintained by biennial screening, and changing from annual to biennial screening is likely to reduce the harms of mammography screening by nearly half. At the same time, benefit may be reduced when extending the interval beyond 24 months; therefore, the USPSTF recommends biennial screening.

Treatment

Effective treatments, including radiation, chemotherapy (including hormonal treatment), and surgery, are available for invasive carcinoma. Although the standard treatments women receive for ductal carcinoma in situ (DCIS) include surgical approaches as well as radiation and hormonal therapy, considerable debate exists about the optimal treatment strategy for this condition.

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