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Breast Cancer Screening Guidelines

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Last Modified: October 19, 2007

Dear OncoLink "Ask The Experts,"

What are the current guidelines for breast cancer screening?

Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:

The American Cancer Society (ACS) and the National Comprehensive Cancer Network (NCCN) have both developed breast cancer screening guidelines which are quite similar. These recommendations are broken down into categories based on age and risk. Let's review the average and above average risk categories.

Average Risk includes women without symptoms (a lump, swelling, redness or scaling) and:

• No family history of breast cancer in a first degree relative (sibling or parent) or hereditary (genetic) syndrome
• No personal history of breast cancer, ductal or lobular carcinoma in situ or atypical hyperplasia
• No personal history of radiation therapy for Hodgkin's disease (called mantle irradiation)

Above average risk includes those women with:

• A family history of breast cancer in a first degree relative (parent or sibling) or evidence of a hereditary (genetic) syndrome
• A personal diagnosis of atypical hyperplasia (atypia), ductal or lobular carcinoma in situ or invasive breast cancer
• A personal history of mantle radiation for Hodgkin's disease
• Women, over age 35, whose risk score using the Gail Model (a risk evaluation tool) is > 1.7%

Now let's review the guidelines for each group.

Age 20-39, average risk

• Clinical breast exam (performed by a healthcare professional) every one to three years.
• Women are encouraged to become aware of the normal look and feel of their breasts. Any changes or new findings should be reported to their healthcare provider. Breast self exam has not been shown in studies to reduce breast cancer deaths, but it is a good way for a woman to ?get to know? her own breasts.

Age 40 and over, average risk

• Yearly mammogram
• Yearly clinical breast exam by a healthcare professional, preferably near the time of the mammogram
• Women are encouraged to become aware of the normal look and feel of their breasts. Any changes or new findings should be reported to their healthcare provider. Breast self exam has not been shown in studies to reduce breast cancer deaths, but it is a good way for a woman to ?get to know? her own breasts.

Above average risk

The ACS encourages women at above average risk to talk with their healthcare providers about the best screening plan for them. The NCCN provides some specific recommendations for these women (reviewed below), which should be discussed with your healthcare provider.

Personal history of LCIS or atypical hyperplasia

• Annual mammogram
• Clinical breast exam every 6-12 months by healthcare professional
• Periodic self breast exam
• Consider risk-reduction strategies, including surgical and medication interventions

Family history or hereditary (genetic) syndrome

• Age under 25:
• Annual clinical breast exam and periodic breast self exam
• Age over 25:
• Annual mammogram and clinical breast exam every 6-12 months
• Starts at age 25 for hereditary breast and ovarian cancer syndromes
• All others start 5-10 years prior to youngest family cancer case (breast cancer or related cancer)
• Periodic self breast exam encouraged
• Consider breast MRI in conjunction with mammogram
• Consider risk reduction strategies, including surgical and medication interventions

Gail Model risk > 1.7%

• Annual mammogram and clinical breast exam every 6-12 months
• Periodic breast self exam encouraged
• Consider risk reduction strategies, including surgical and medication interventions

Personal history of mantle radiation for Hodgkin's disease

• Age under 25:
• Annual clinical breast exam and periodic breast self exam
• Age over 25:
• Annual mammogram and clinical breast exam every 6-12 months
• Begin 8-10 years after radiation therapy or age 40, whichever is first
• Periodic self breast exam encouraged

Previous diagnosis of breast cancer

• Mammogram every 12 months
• Seen and examined by their healthcare provider every 4 to 6 months for five years, then every 12 months

As, always, discuss your particular situation with your healthcare provider. In addition, maintaining a healthy weight, limiting alcohol intake to no more than 1 drink per day, performing regular exercise and not smoking are thought to help decrease risk.

Learn how to perform a self breast exam.