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Screening for breast cancer: Strategies and recommendations

Joann G Elmore, MD, MPH
Section Editor
Mark D Aronson, MD
Deputy Editor
Sadhna R Vora, MD


There is more scientific evidence regarding screening for breast cancer, the most common nonskin cancer and second deadliest cancer in women, than for any other cancer. As with all cancer screening, recommendations for breast cancer screening rely on a combination of factors involving evidence about the risk of the condition, the benefits and harms of screening, and the cost.

When considering breast cancer screening, specific issues include determining who should be screened (risk stratification, age to begin screening, age to stop) and what method should be used for screening. As more information has become available about the occurrence of false-positive test results and overdiagnosis, and with increasingly more effective treatment for breast cancer, the trade-offs between benefits and harms of breast cancer screening have received increasing attention.

Recommendations for breast cancer screening, including breast cancer risk and other parameters that might affect screening decisions, are discussed here. These recommendations, based upon the evidence for screening for breast cancer in women, weigh benefits and harms of screening. Benefits and harms, in turn, will depend upon an individual's risk of developing and dying of breast cancer, how good the screening test is, how effective and tolerable the treatment is, and the woman's own personal values. The evidence for the effectiveness and harms of screening for breast cancer in women, performance characteristics of mammography, and patient risk stratification are discussed in detail separately. (See "Screening for breast cancer: Evidence for effectiveness and harms" and "Breast imaging for cancer screening: Mammography and ultrasonography" and "Risk prediction models for breast cancer screening".)

Discoveries of genetic mutations that increase the risk of breast cancer and the development of breast cancer risk prediction models have stimulated efforts to develop screening strategies stratified according to risk level. In tandem with mammography, breast magnetic resonance imaging (MRI) has been studied as a screening method for high-risk women. Management options for women with a genetic predisposition to breast cancer, and surveillance in women with a personal history of breast cancer, are discussed in detail separately. (See "Management of patients at high risk for breast and ovarian cancer" and "Approach to the patient following treatment for breast cancer".)


Worldwide in 2013 there were about 1.8 million new cases of breast cancer and over 464,000 breast cancer deaths in women [1,2]. About one-half of breast cancer cases, and nearly 60 percent of breast cancer deaths, occur in women in less-developed countries [3]. In the United States, it is estimated that approximately 234,190 women will be diagnosed with invasive breast cancer, and 40,730 women will die from the disease in 2014 [4].


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Literature review current through: Sep 2016. | This topic last updated: Aug 26, 2016.
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