Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Screening for breast cancer: Evidence for effectiveness and harms

Joann G Elmore, MD, MPH
Section Editor
Mark D Aronson, MD
Deputy Editor
Judith A Melin, MA, MD, FACP


There is more scientific evidence related to screening for breast cancer, the most common nonskin cancer and second deadliest cancer in women, than for any other cancer.

Decisions about screening require evidence related to effectiveness and harms of screening, and risk of the condition, considered in the context of the patient's values. The evidence addressing the effectiveness (decreasing breast cancer mortality) of several modalities for screening for breast cancer in women and harms that occur from breast cancer screening are discussed here. Multiple aspects related to breast cancer screening are discussed in separate topics, as follows:

Strategies and recommendations for breast cancer screening (see "Screening for breast cancer: Strategies and recommendations")

Breast cancer risk and risk prediction models

Performance characteristics of mammography (see "Breast imaging for cancer screening: Mammography and ultrasonography")

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Jan 23, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Berg WA. Tailored supplemental screening for breast cancer: what now and what next? AJR Am J Roentgenol 2009; 192:390.
  2. Breast Cancer Surveillance Consortium (funded by the National Cancer Institute) http://breastscreening.cancer.gov (Accessed on March 06, 2014).
  3. Miller AB, Wall C, Baines CJ, et al. Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial. BMJ 2014; 348:g366.
  4. Independent UK Panel on Breast Cancer Screening. The benefits and harms of breast cancer screening: an independent review. Lancet 2012; 380:1778.
  5. Nelson HD, Tyne K, Naik A, et al. Screening for breast cancer: an update for the U.S. Preventive Services Task Force. Ann Intern Med 2009; 151:727.
  6. Nyström L, Andersson I, Bjurstam N, et al. Long-term effects of mammography screening: updated overview of the Swedish randomised trials. Lancet 2002; 359:909.
  7. Freedman DA, Petitti DB, Robins JM. On the efficacy of screening for breast cancer. Int J Epidemiol 2004; 33:43.
  8. Breast cancer screening. In: IARC Handbook of cancer prevention, Vainio H, Bianchini F (Eds), Lyon IARC Press, Lyon, France 2002. Vol 7.
  9. National Cancer Institute. Breast Cancer (PDQ®): Screening. Available at: http://cancer.gov/cancertopics/pdq/screening/breast/healthprofessional (Accessed on November 15, 2006).
  10. Schopper D, de Wolf C. How effective are breast cancer screening programmes by mammography? Review of the current evidence. Eur J Cancer 2009; 45:1916.
  11. Autier P, Koechlin A, Smans M, et al. Mammography screening and breast cancer mortality in Sweden. J Natl Cancer Inst 2012; 104:1080.
  12. Gøtzsche PC, Jørgensen KJ. Screening for breast cancer with mammography. Cochrane Database Syst Rev 2013; :CD001877.
  13. Berry DA, Cronin KA, Plevritis SK, et al. Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med 2005; 353:1784.
  14. Kalager M, Zelen M, Langmark F, Adami HO. Effect of screening mammography on breast-cancer mortality in Norway. N Engl J Med 2010; 363:1203.
  15. Weedon-Fekjær H, Romundstad PR, Vatten LJ. Modern mammography screening and breast cancer mortality: population study. BMJ 2014; 348:g3701.
  16. Otto SJ, Fracheboud J, Verbeek AL, et al. Mammography screening and risk of breast cancer death: a population-based case-control study. Cancer Epidemiol Biomarkers Prev 2012; 21:66.
  17. Elmore JG, Reisch LM, Barton MB, et al. Efficacy of breast cancer screening in the community according to risk level. J Natl Cancer Inst 2005; 97:1035.
  18. Lauby-Secretan B, Scoccianti C, Loomis D, et al. Breast-cancer screening--viewpoint of the IARC Working Group. N Engl J Med 2015; 372:2353.
  19. Pisano ED, Yaffe MJ. Digital mammography. Radiology 2005; 234:353.
  20. http://www.fda.gov/Radiation-EmittingProducts/MammographyQualityStandardsActandProgram/Document Archives/ucm432658.htm#may (Accessed on June 26, 2015).
  21. Lewin JM, D'Orsi CJ, Hendrick RE, et al. Clinical comparison of full-field digital mammography and screen-film mammography for detection of breast cancer. AJR Am J Roentgenol 2002; 179:671.
  22. Skaane P, Young K, Skjennald A. Population-based mammography screening: comparison of screen-film and full-field digital mammography with soft-copy reading--Oslo I study. Radiology 2003; 229:877.
  23. Skaane P, Skjennald A. Screen-film mammography versus full-field digital mammography with soft-copy reading: randomized trial in a population-based screening program--the Oslo II Study. Radiology 2004; 232:197.
  24. Pisano ED, Gatsonis C, Hendrick E, et al. Diagnostic performance of digital versus film mammography for breast-cancer screening. N Engl J Med 2005; 353:1773.
  25. Skaane P, Hofvind S, Skjennald A. Randomized trial of screen-film versus full-field digital mammography with soft-copy reading in population-based screening program: follow-up and final results of Oslo II study. Radiology 2007; 244:708.
  26. Kerlikowske K, Hubbard RA, Miglioretti DL, et al. Comparative Effectiveness of Digital Versus Film-Screen Mammography in Community Practice in the United States: A Cohort Study. Ann Intern Med 2011; 155:493.
  27. Pisano ED, Hendrick RE, Yaffe MJ, et al. Diagnostic accuracy of digital versus film mammography: exploratory analysis of selected population subgroups in DMIST. Radiology 2008; 246:376.
  28. van Ravesteyn NT, Miglioretti DL, Stout NK, et al. Tipping the balance of benefits and harms to favor screening mammography starting at age 40 years: a comparative modeling study of risk. Ann Intern Med 2012; 156:609.
  29. Moore SG, Shenoy PJ, Fanucchi L, et al. Cost-effectiveness of MRI compared to mammography for breast cancer screening in a high risk population. BMC Health Serv Res 2009; 9:9.
  30. Morris EA, Liberman L, Ballon DJ, et al. MRI of occult breast carcinoma in a high-risk population. AJR Am J Roentgenol 2003; 181:619.
  31. Tilanus-Linthorst MM, Obdeijn IM, Bartels KC, et al. First experiences in screening women at high risk for breast cancer with MR imaging. Breast Cancer Res Treat 2000; 63:53.
  32. Warner E, Plewes DB, Hill KA, et al. Surveillance of BRCA1 and BRCA2 mutation carriers with magnetic resonance imaging, ultrasound, mammography, and clinical breast examination. JAMA 2004; 292:1317.
  33. Stoutjesdijk MJ, Boetes C, Jager GJ, et al. Magnetic resonance imaging and mammography in women with a hereditary risk of breast cancer. J Natl Cancer Inst 2001; 93:1095.
  34. Kuhl CK, Schrading S, Leutner CC, et al. Mammography, breast ultrasound, and magnetic resonance imaging for surveillance of women at high familial risk for breast cancer. J Clin Oncol 2005; 23:8469.
  35. Kriege M, Brekelmans CT, Boetes C, et al. Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. N Engl J Med 2004; 351:427.
  36. Lehman CD, Isaacs C, Schnall MD, et al. Cancer yield of mammography, MR, and US in high-risk women: prospective multi-institution breast cancer screening study. Radiology 2007; 244:381.
  37. Leach MO, Boggis CR, Dixon AK, et al. Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS). Lancet 2005; 365:1769.
  38. Lehman CD, Blume JD, Weatherall P, et al. Screening women at high risk for breast cancer with mammography and magnetic resonance imaging. Cancer 2005; 103:1898.
  39. Berg WA, Zhang Z, Lehrer D, et al. Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA 2012; 307:1394.
  40. Warner E, Messersmith H, Causer P, et al. Systematic review: using magnetic resonance imaging to screen women at high risk for breast cancer. Ann Intern Med 2008; 148:671.
  41. Rijnsburger AJ, Obdeijn IM, Kaas R, et al. BRCA1-associated breast cancers present differently from BRCA2-associated and familial cases: long-term follow-up of the Dutch MRISC Screening Study. J Clin Oncol 2010; 28:5265.
  42. Passaperuma K, Warner E, Causer PA, et al. Long-term results of screening with magnetic resonance imaging in women with BRCA mutations. Br J Cancer 2012; 107:24.
  43. Kuhl CK, Schrading S, Strobel K, et al. Abbreviated breast magnetic resonance imaging (MRI): first postcontrast subtracted images and maximum-intensity projection-a novel approach to breast cancer screening with MRI. J Clin Oncol 2014; 32:2304.
  44. Brenner RJ, Parisky Y. Alternative breast-imaging approaches. Radiol Clin North Am 2007; 45:907.
  45. Moskowitz M, Milbrath J, Gartside P, et al. Lack of efficacy of thermography as a screening tool for minimal and stage I breast cancer. N Engl J Med 1976; 295:249.
  46. www.cancer.org/acs/groups/cid/documents/webcontent/003178-pdf.pdf. (Accessed on December 29, 2010).
  47. Lee CH, Dershaw DD, Kopans D, et al. Breast cancer screening with imaging: recommendations from the Society of Breast Imaging and the ACR on the use of mammography, breast MRI, breast ultrasound, and other technologies for the detection of clinically occult breast cancer. J Am Coll Radiol 2010; 7:18.
  48. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm257707.htm.
  49. U.S. Food and Drug Administration approved devices http://fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearance/Recently-ApprovedDevices/ucm246400.htm (Accessed on March 06, 2014).
  50. Skaane P, Bandos AI, Gullien R, et al. Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program. Radiology 2013; 267:47.
  51. Ciatto S, Houssami N, Bernardi D, et al. Integration of 3D digital mammography with tomosynthesis for population breast-cancer screening (STORM): a prospective comparison study. Lancet Oncol 2013; 14:583.
  52. Friedewald SM, Rafferty EA, Rose SL, et al. Breast cancer screening using tomosynthesis in combination with digital mammography. JAMA 2014; 311:2499.
  53. Wallis MG, Moa E, Zanca F, et al. Two-view and single-view tomosynthesis versus full-field digital mammography: high-resolution X-ray imaging observer study. Radiology 2012; 262:788.
  54. Lee CI, Cevik M, Alagoz O, et al. Comparative effectiveness of combined digital mammography and tomosynthesis screening for women with dense breasts. Radiology 2015; 274:772.
  55. Miller AB, Baines CJ, To T, Wall C. Canadian National Breast Screening Study: 2. Breast cancer detection and death rates among women aged 50 to 59 years. CMAJ 1992; 147:1477.
  56. Miller AB, To T, Baines CJ, Wall C. Canadian National Breast Screening Study-2: 13-year results of a randomized trial in women aged 50-59 years. J Natl Cancer Inst 2000; 92:1490.
  57. Barton MB, Harris R, Fletcher SW. The rational clinical examination. Does this patient have breast cancer? The screening clinical breast examination: should it be done? How? JAMA 1999; 282:1270.
  58. Chiarelli AM, Majpruz V, Brown P, et al. The contribution of clinical breast examination to the accuracy of breast screening. J Natl Cancer Inst 2009; 101:1236.
  59. Fenton JJ, Barton MB, Geiger AM, et al. Screening clinical breast examination: how often does it miss lethal breast cancer? J Natl Cancer Inst Monogr 2005; :67.
  60. Bobo JK, Lee NC, Thames SF. Findings from 752,081 clinical breast examinations reported to a national screening program from 1995 through 1998. J Natl Cancer Inst 2000; 92:971.
  61. Fenton JJ, Rolnick SJ, Harris EL, et al. Specificity of clinical breast examination in community practice. J Gen Intern Med 2007; 22:332.
  62. Kösters JP, Gøtzsche PC. Regular self-examination or clinical examination for early detection of breast cancer. Cochrane Database Syst Rev 2003; :CD003373.
  63. Thomas DB, Gao DL, Ray RM, et al. Randomized trial of breast self-examination in Shanghai: final results. J Natl Cancer Inst 2002; 94:1445.
  64. Baxter N, Canadian Task Force on Preventive Health Care. Preventive health care, 2001 update: should women be routinely taught breast self-examination to screen for breast cancer? CMAJ 2001; 164:1837.
  65. Hackshaw AK, Paul EA. Breast self-examination and death from breast cancer: a meta-analysis. Br J Cancer 2003; 88:1047.
  66. Harvey BJ, Miller AB, Baines CJ, Corey PN. Effect of breast self-examination techniques on the risk of death from breast cancer. CMAJ 1997; 157:1205.
  67. Newcomb PA, Weiss NS, Storer BE, et al. Breast self-examination in relation to the occurrence of advanced breast cancer. J Natl Cancer Inst 1991; 83:260.
  68. Qin XJ, Ling BX. Proteomic studies in breast cancer (Review). Oncol Lett 2012; 3:735.
  69. Elmore JG, Barton MB, Moceri VM, et al. Ten-year risk of false positive screening mammograms and clinical breast examinations. N Engl J Med 1998; 338:1089.
  70. Brown ML, Houn F, Sickles EA, Kessler LG. Screening mammography in community practice: positive predictive value of abnormal findings and yield of follow-up diagnostic procedures. AJR Am J Roentgenol 1995; 165:1373.
  71. Breast Cancer Surveillance Consortium, funded by the National Cancer Institute http://breastscreening.cancer.gov/.
  72. Kerlikowske K, Grady D, Barclay J, et al. Positive predictive value of screening mammography by age and family history of breast cancer. JAMA 1993; 270:2444.
  73. Lidbrink E, Elfving J, Frisell J, Jonsson E. Neglected aspects of false positive findings of mammography in breast cancer screening: analysis of false positive cases from the Stockholm trial. BMJ 1996; 312:273.
  74. Mandelblatt JS, Cronin KA, Bailey S, et al. Effects of mammography screening under different screening schedules: model estimates of potential benefits and harms. Ann Intern Med 2009; 151:738.
  75. Hubbard RA, Kerlikowske K, Flowers CI, et al. Cumulative probability of false-positive recall or biopsy recommendation after 10 years of screening mammography: a cohort study. Ann Intern Med 2011; 155:481.
  76. Christiansen CL, Wang F, Barton MB, et al. Predicting the cumulative risk of false-positive mammograms. J Natl Cancer Inst 2000; 92:1657.
  77. Schousboe JT, Kerlikowske K, Loh A, Cummings SR. Personalizing mammography by breast density and other risk factors for breast cancer: analysis of health benefits and cost-effectiveness. Ann Intern Med 2011; 155:10.
  78. Welch HG, Fisher ES. Diagnostic testing following screening mammography in the elderly. J Natl Cancer Inst 1998; 90:1389.
  79. Elmore JG, Nakano CY, Koepsell TD, et al. International variation in screening mammography interpretations in community-based programs. J Natl Cancer Inst 2003; 95:1384.
  80. Smith-Bindman R, Chu PW, Miglioretti DL, et al. Comparison of screening mammography in the United States and the United kingdom. JAMA 2003; 290:2129.
  81. Tyndel S, Austoker J, Henderson BJ, et al. What is the psychological impact of mammographic screening on younger women with a family history of breast cancer? Findings from a prospective cohort study by the PIMMS Management Group. J Clin Oncol 2007; 25:3823.
  82. Brewer NT, Salz T, Lillie SE. Systematic review: the long-term effects of false-positive mammograms. Ann Intern Med 2007; 146:502.
  83. Lerman C, Trock B, Rimer BK, et al. Psychological and behavioral implications of abnormal mammograms. Ann Intern Med 1991; 114:657.
  84. Schou Bredal I, Kåresen R, Skaane P, et al. Recall mammography and psychological distress. Eur J Cancer 2013; 49:805.
  85. Tosteson AN, Fryback DG, Hammond CS, et al. Consequences of false-positive screening mammograms. JAMA Intern Med 2014; 174:954.
  86. Barton MB, Morley DS, Moore S, et al. Decreasing women's anxieties after abnormal mammograms: a controlled trial. J Natl Cancer Inst 2004; 96:529.
  87. Brodersen J, Siersma VD. Long-term psychosocial consequences of false-positive screening mammography. Ann Fam Med 2013; 11:106.
  88. Brett J, Austoker J. Women who are recalled for further investigation for breast screening: psychological consequences 3 years after recall and factors affecting re-attendance. J Public Health Med 2001; 23:292.
  89. Barton MB, Moore S, Polk S, et al. Increased patient concern after false-positive mammograms: clinician documentation and subsequent ambulatory visits. J Gen Intern Med 2001; 16:150.
  90. Jørgensen KJ, Gøtzsche PC. Overdiagnosis in publicly organised mammography screening programmes: systematic review of incidence trends. BMJ 2009; 339:b2587.
  91. Etzioni R, Gulati R, Mallinger L, Mandelblatt J. Influence of study features and methods on overdiagnosis estimates in breast and prostate cancer screening. Ann Intern Med 2013; 158:831.
  92. Coldman A, Phillips N. Incidence of breast cancer and estimates of overdiagnosis after the initiation of a population-based mammography screening program. CMAJ 2013; 185:E492.
  93. Esserman L, Shieh Y, Thompson I. Rethinking screening for breast cancer and prostate cancer. JAMA 2009; 302:1685.
  94. Moss S. Overdiagnosis and overtreatment of breast cancer: overdiagnosis in randomised controlled trials of breast cancer screening. Breast Cancer Res 2005; 7:230.
  95. Welch HG, Prorok PC, O'Malley AJ, Kramer BS. Breast-Cancer Tumor Size, Overdiagnosis, and Mammography Screening Effectiveness. N Engl J Med 2016; 375:1438.
  96. Bleyer A, Welch HG. Effect of three decades of screening mammography on breast-cancer incidence. N Engl J Med 2012; 367:1998.
  97. Harding C, Pompei F, Burmistrov D, et al. Breast Cancer Screening, Incidence, and Mortality Across US Counties. JAMA Intern Med 2015; 175:1483.
  98. Kalager M, Adami HO, Bretthauer M, Tamimi RM. Overdiagnosis of invasive breast cancer due to mammography screening: results from the Norwegian screening program. Ann Intern Med 2012; 156:491.
  99. Falk RS, Hofvind S, Skaane P, Haldorsen T. Overdiagnosis among women attending a population-based mammography screening program. Int J Cancer 2013; 133:705.
  100. Heinävaara S, Sarkeala T, Anttila A. Overdiagnosis due to breast cancer screening: updated estimates of the Helsinki service study in Finland. Br J Cancer 2014; 111:1463.
  101. Zahl PH, Strand BH, Maehlen J. Incidence of breast cancer in Norway and Sweden during introduction of nationwide screening: prospective cohort study. BMJ 2004; 328:921.
  102. Jørgensen KJ, Gøtzsche PC, Kalager M, and Zahl P. Breast Cancer Screening in Denmark: A Cohort Study of Tumor Size and Overdiagnosis. Ann Intern Med 2017.
  103. National Institutes of Health State-of-the-Science Conference Statement: Diagnosis and Management of Ductal Carcinoma In Situ (DCIS). http://consensus.nih.gov/2009/dcis.htm (Accessed on April 05, 2012).
  104. Brinton LA, Sherman ME, Carreon JD, Anderson WF. Recent trends in breast cancer among younger women in the United States. J Natl Cancer Inst 2008; 100:1643.
  105. Virnig BA, Tuttle TM, Shamliyan T, Kane RL. Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes. J Natl Cancer Inst 2010; 102:170.
  106. Cancer facts & figures 2015 http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-044552.pdf (Accessed on April 02, 2015).
  107. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin 2015; 65:5.
  108. Welch HG, Woloshin S, Schwartz LM. The sea of uncertainty surrounding ductal carcinoma in situ--the price of screening mammography. J Natl Cancer Inst 2008; 100:228.
  109. Elmore JG, Longton GM, Carney PA, et al. Diagnostic concordance among pathologists interpreting breast biopsy specimens. JAMA 2015; 313:1122.
  110. Preston DL, Mattsson A, Holmberg E, et al. Radiation effects on breast cancer risk: a pooled analysis of eight cohorts. Radiat Res 2002; 158:220.
  111. Ronckers CM, Erdmann CA, Land CE. Radiation and breast cancer: a review of current evidence. Breast Cancer Res 2005; 7:21.
  112. Modeling report: Radiation-induced breast cancer and breast cancer death from mammography screening. Supporting document for U.S. Preventive Services Task Force; Breast cancer screening draft recommendations. http://www.uspreventiveservicestaskforce.org/Page/Document/modeling-report-radiation-induced-breast-cancer-and-breast-c/breast-cancer-screening1 (Accessed on June 26, 2015).
  113. Berrington de González A, Reeves G. Mammographic screening before age 50 years in the UK: comparison of the radiation risks with the mortality benefits. Br J Cancer 2005; 93:590.
  114. Yaffe MJ, Mainprize JG. Risk of radiation-induced breast cancer from mammographic screening. Radiology 2011; 258:98.
  115. Miller D, Martin I, Herbison P. Interventions for relieving the pain and discomfort of screening mammography. Cochrane Database Syst Rev 2002; :CD002942.
  116. Kornguth PJ, Rimer BK, Conaway MR, et al. Impact of patient-controlled compression on the mammography experience. Radiology 1993; 186:99.
  117. Lambertz CK, Johnson CJ, Montgomery PG, Maxwell JR. Premedication to reduce discomfort during screening mammography. Radiology 2008; 248:765.