Breast Cancer Screening for Women at Average Risk

The Women’s Preventive Services Initiative recommends that women at average risk of breast cancer initiate mammography screening no earlier than age 40 years and no later than age 50 years. Screening mammography should occur at least biennially and as frequently as annually. Women may require additional imaging to complete the screening process or to address findings on the initial screening mammography. If additional imaging (eg, magnetic resonance imaging, ultrasound, mammography) and pathology evaluation are indicated, these services also are recommended to complete the screening process for malignancies. Screening should continue through at least age 74 years, and age alone should not be the basis for discontinuing screening.

Women at increased risk also should undergo periodic mammography screening, however, recommendations for additional services are beyond the scope of this recommendation.

Decisions regarding when to initiate screening, how often to screen, and when to stop screening should be based on a periodic shared decision-making process involving the woman and her health care clinician. The shared decision-making process assists women in making informed decisions and includes, but is not limited to, a discussion about the benefits and harms of screening, an assessment of the woman’s values and preferences, and consideration of factors such as life expectancy, comorbidities, and health status. Discussion and education related to screening should be culturally and linguistically congruent, particularly for patients experiencing health inequities.

Women considered at high risk of breast cancer (eg, previous diagnosis of breast or ovarian cancer, known BRCA1 or BRCA2 mutation, previous high-dose radiation to the chest) may require additional testing and closer follow-up, which are beyond the scope of this recommendation.

• Trials and comparative studies of the benefits, harms, and effectiveness of mammography
  screening with health outcomes for women aged 75 years and older.
• Comparative effectiveness trials of different screening modalities and screening intervals on
  health outcomes (eg, cancer detection, breast cancer mortality, all-cause mortality) for women
  at various levels of breast cancer risk (eg, family history of breast cancer, previous abnormal
  breast lesion, high breast density, among others).
• Studies evaluating the impact of shared decision making on when to start and stop screening.
• Studies examining contributors to disparities in rates of breast cancer screening and barriers to
  follow-up care.
• Studies evaluating the effectiveness of education and engagement approaches to increase
  screening, specifically for patients at risk of health disparities.