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Screening for Breast Cancer

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There is controversy in when to initiate and how often to screen for breast cancer with mammography. Below is a summary of various aspects of screening for breast cancer. A more detailed report can be found at the US Preventative Services Task Force (USPSTF) website:

http://www.ahrq.gov/clinic/uspstf/uspsbrca.htm

When to start screening with mammography?

All guidelines released by major North American organizations recommend screening mammography for women>50 years old. The majority of controversy lies whether to screen women between 40-49.

The US Preventive Services Task Force in an update published in the November 2009 issue of Annals of Internal Medicine, summarized the existing trial data examining benefit of breast cancer screening in women in their 40s and recommended against screening women under 50 based on pooled analysis, and suggests screening should end at age 74.

The American Medical Association (AMA), the American College of Obstetricians and Gynecologists (ACOG), the American College of Radiology (ACR), and the American Cancer Society (ACS), all support screening with mammography beginning at age 40. The USPSTF, Canadian Task Force on Preventive Health Care (CTFPHC), the American Academy of Family Physicians (AAFP), and the American College of Preventive Medicine (ACPM) recommend initiating mammography for average-risk women at age 50. AAFP and ACPM recommend that mammography in high-risk women begin at age 40, and AAFP recommends that all women aged 40-49 be counseled about the risks and benefits of mammography before making decisions about screening.

In that competing causes of mortality decrease the effectiveness of any screening program, at Madison Clinic the decision of when to start screening for breast cancer is complex. The majority of US organizations recommend initiating screening for breast cancer at the age of 40 while others recommend initiating screening at the age of 50. At Madison Clinic we accept either approach. It seems prudent to involve the patient in this complex decision.

How often to screen for breast cancer?

The USPSTF recommends biennial screening for women aged 50-74 years and notes that “ there is little evidence to suggest that annual mammography is more effective than mammography done every other year .”

However, annual mammography is recommended by AMA, ACR, and ACS. Mammography every 1-2 years is recommended by USPSTF, AAFP, ACPM, and the CTFPHC. ACOG recommends annual mammography every 1-2 years for women aged 40-49 and annually for women aged 50 and older.

Should a routine clinical breast exams or routine self-breast exams be performed?

The USPSTF considers there to be insufficient evidence to recommend for or against clinical breast examination . They do, however, note that the evidence offers moderate certainty that the harms of breast self-examination outweigh the benefits.

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