Recommendation Statement From USPSTF: Screening for Breast Cancer

US Preventive Services Task Force (USPSTF)

Disclosures

December 17, 2009

In This Article

Update of Previous USPSTF Recommendation

This recommendation updates the 2002 recommendation by providing specific recommendations for mammography screening by age. The previous recommendation statement recommended screening mammography every 1-2 years for all women older than 40 years. The USPSTF now recommends against routine screening of women aged 40-49 years (C recommendation), recommends biennial screening mammography for all women aged 50-74 years (B recommendation), and provides an I statement regarding screening of women older than 75 years. The USPSTF now recommends against teaching BSE (D recommendation), replacing the previous statement of insufficient evidence. The evidence for CBE continues to be assessed as insufficient. Digital mammography and MRI as screening tools were not addressed in the 2002 recommendation statement; the USPSTF concludes that the evidence is insufficient to assess the harms or benefits of these methods for screening.

Recommendations of Others

Numerous organizations have provided breast cancer screening recommendations. These recommendations are summarized below. All recommendations are for women not at increased risk for breast cancer.

In 2003, the American Cancer Society recommended annual mammography beginning at age 40 years, annual CBE after the age of 40 years.[25] It does not recommend MRI for women at average risk for breast cancer and states that there is insufficient evidence to recommend BSE.

The American Medical Association, in 2002,[26] and the National Comprehensive Cancer Network, in 2009,[27] have made recommendations similar to those of the American Cancer Society, except for the inclusion of a positive recommendation for BSE.

The American Academy of Family Physicians has endorsed the USPSTF recommendation on breast cancer screening in the past.[28] The American College of Physicians recommended in 2007 that: screening mammography decisions in women aged 40-49 years should be based on individualized assessment of risk for breast cancer; clinicians should inform women aged 40-49 years about the potential benefits and harms of screening mammography; and clinicians should base screening mammography decisions on benefits and harms of screening, as well as on a woman's preferences and breast cancer risk profile.[29]

In 2001, the Canadian Task Force on Preventive Health Care recommended mammography every 1-2 years beginning at the age of 40 years and recommended CBE as part of a periodic evaluation (every 1-3 years) for women aged 50-69 years.[30] It does not recommend BSE.

In 2003, the American College of Obstetrics and Gynecology recommended mammography every 1-2 years for women aged 40-49 years and annually after the age of 50 years.[31] It recommended CBE for all women and noted that BSE can be recommended.

In 2009, the World Health Organization recommended mammography every 1-2 years for women aged 50-69 years but does not recommend CBE or BSE.[32]

Members of the USPSTF

Members of the USPSTF* are Ned Calonge, MD, MPH, Chair (Colorado Department of Public Health and Environment, Denver, Colorado); Diana B. Petitti, MD, MPH, Vice-Chair (Arizona State University, Phoenix, Arizona); Thomas G. DeWitt, MD (Children's Hospital Medical Center, Cincinnati, Ohio); Allen J. Dietrich, MD (Dartmouth Medical School, Hanover, New Hampshire); Kimberly D. Gregory, MD, MPH (Cedars-Sinai Medical Center, Los Angeles, California); David Grossman, MD (Group Health Cooperative, Seattle, Washington); George Isham, MD, MS (HealthPartners, Minneapolis, Minnesota); Michael L. LeFevre, MD, MSPH (University of Missouri School of Medicine, Columbia, Missouri); Rosanne M. Leipzig, MD, PhD (Mount Sinai School of Medicine, New York, NY); Lucy N. Marion, PhD, RN (School of Nursing, Medical College of Georgia, Augusta, Georgia); Bernadette Melnyk, PhD, RN (Arizona State University College of Nursing & Health Innovation, Phoenix, Arizona); Virginia A. Moyer, MD, MPH (Baylor College of Medicine, Houston, Texas); Judith K. Ockene, PhD (University of Massachusetts Medical School, Worcester, Massachusetts); George F. Sawaya, MD (University of California, San Francisco, San Francisco, California); J. Sanford Schwartz, MD (University of Pennsylvania Medical School and the Wharton School, Philadelphia, Pennsylvania); and Timothy Wilt, MD, MPH (University of Minnesota Department of Medicine and Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota).

*Members of the Task Force at the time this recommendation was finalized. For a list of current Task Force members, go to http://www.ahrq.gov/clinic/uspstfab.htm

Disclaimer: Recommendations made by the USPSTF are independent of the US government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the US Department of Health and Human Services.

Copyright and Source Information
This document is in the public domain within the United States. For information on reprinting, contact Randie Siegel, Associate Director, Office of Communications and Knowledge Transfer, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850.

Requests for linking or to incorporate content in electronic resources should be sent to: info@ahrq.gov.

Source: US Preventive Services Task Force. Screening for breast cancer: US Preventive Services Task Force Recommendation Statement. Ann Intern Med 2009;151:716-726.
AHRQ Publication No. 10-05142-EF-2
Current as of December 2009

Internet Citation:
US Preventive Services Task Force. Screening for Breast Cancer: Recommendation Statement. AHRQ Publication No. 10-05142-EF-2, November 2009. Agency for Healthcare Research and Quality, Rockville, Md. http://www.ahrq.gov/clinic/uspstf09/breastcancer/brcanrs.htm

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