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Breast Cancer Screening Guidelines


By Dr. Marla Anderson

General Surgeon

The updated fundamentals of breast cancer screening are screening mammogram, clinical breast exam (CBE), and practicing breast self awareness. Sometimes magnetic resonance imaging (MRI) for a select population of women is recommended. The recommended guidelines depend on a woman’s particular risk for developing breast cancer.

Screening mammograms are associated with earlier breast cancer detection and decreased breast cancer mortality. The value of annual screening mammograms has been proven for most women age 40 and older.

A CBE is a breast exam performed by a health care practitioner. There is some evidence that CBE identify more cancers than mammograms alone and, with inference from the published studies, CBE is thought to reduce breast cancer mortality. The benefit of CBE is stronger for women with a family history of breast cancer and older women with dense breast tissue. Though evidence is limited, most major organizations recommend CBE and view it as an opportunity to discuss with your health care practitioner general breast health. Effort should be made to schedule your CBE close to the time of your screening mammogram.

Updated guidelines now focus on breast self awareness (as opposed to a structured self breast exam, or SBE). Breast self awareness emphasizes the importance for a woman to have an overall familiarity with her breasts. This means paying attention to the shape of your breasts, how they feel, being aware of any changes in your breasts (for example, new or changing lumps, dimpling, redness, new sensations, changes in nipple appearance such as retraction, nipple discharge or scaling), occasionally performing a SBE, and being aware of any changes in the underarm area. Surprisingly, there is no clear evidence that performing a monthly SBE reduces breast cancer mortality or identifies more breast cancers than screening mammogram alone.  Further, most breast cancers that were noticed as a mass by a woman were found outside of the routine structured SBE.  Therefore, monthly SBE is considered optional by most major organizations.

The American Cancer Society recommends that women should be informed about the benefits and limitations of SBE, that SBE is optional,  and women who do chose to perform SBE should receive or have access to appropriate instruction for performing SBE. The SBE no longer needs to be regimented, and its benefit is derived from getting to know how your own breast tissue looks and feels.  Now I know many of you will say, “My breasts are so lumpy, I do not know what I am feeling.” The truth is most breasts are “lumpy”, and over time you will intuitively get to know the feel of your own breast tissue -- your own lumps and bumps.  This familiarity will help you notice subtle changes in your breast, and if you notice a change in your breasts, promptly report this information to your health care practitioner so that the appropriate work up can be initiated.

MRI can be a useful additional screening tool for a limited population of women considered to be at very high risk. It is not useful as a screening tool for all women. A discussion with your health care practitioner to determine whether you are at high risk for developing breast cancer and whether or not you would benefit from yearly MRI should take place. But remember, MRI does not replace annual screening mammogram and should be performed as an adjunct.

Various organizations and major cancer centers disagree on the specifics of the breast cancer screening guidelines. I have summarized information below using the more frequent recommendations where variation exists.

Screening Recommendations

Average Risk
Women with an average risk of developing breast cancer are those who do not fall into the categories listed below under increased risk.

Current recommendations for breast cancer screening for women with average risk by most major organizations are:

For ages 20-39

  • CBE every 1-3 years
  • Practice breast self awareness (SBE optional)


Age 40 and older

  • Annual screening mammogram
  • Screening should continue with no upper age limit if the women remains in good health and does not have a limited life expectancy.
  • Annual CBE
  •  Practice breast self awareness (SBE optional)



Increased Risk
Women can use a statistical tool known as the Gail Model to predict their individual risk of developing breast cancer. The Gail Model calculates a woman’s breast cancer risk over the next five years, in addition to her lifetime risk. However, there are limitations of the Gail Model including underestimating risk for women with a family history of ovarian cancer or an extended family history of breast cancer. If you are at an increased risk for developing breast cancer, then I recommend discussing this risk with your health care provider because a referral to a specialist in this area to calculate a more accurate risk may be indicated.  A breast cancer risk assessment tool based on the Gail Model is available at the National Cancer Institute website http://www.cancer.gov/bcrisktool/.

Women who are at an increased risk for developing breast cancer are:
  • Those with a personal history of breast cancer, lobular carcinoma in situ   (LCIS), or atypical hyperplasia
  • Those with evidence of a genetic predisposition for developing breast cancer
  • Those with a history of prior chest or mantle radiation
  • Those with a predicted five-year risk of breast cancer greater than 1.7% for women age 35 and older
  • Those with an average lifetime risk for developing breast cancer of 20% or   higher


Specialized breast cancer screening recommendations for each increased risk group follow:               

1. History of breast cancer, LCIS, or atypical hyperplasia.
    Beginning at the time of diagnosis:

  • Annual mammogram (usually not earlier than age 25) and yearly CBE;
  • Practice breast self awareness (SBE optional);
  • May benefit from annual MRI (discuss with your practitioner).


2.  Genetic predisposition

  • Yearly CBE starting age 20
  • Annual mammogram and annual MRI beginning 10 years before the age of the youngest family member diagnosed with breast cancer but not earlier than age 25 and no later than age 40
  • Practice breast self awareness (SBE optional).


3.  History of prior chest or mantle radiation

  • Yearly CBE
  • Annual mammogram 8 years after radiation treatment but not earlier than age 25 and no later than age 40
  • Practice breast self awareness (SBE optional)
  • Consider annual MRI on same timeline as mammogram (discuss with your practitioner).


4.  Predicted five year risk of breast cancer greater than 1.7%

  • Annual mammogram and yearly CBE beginning age 35
  • Practice breast self awareness (SBE optional).


5.  Women at an average lifetime risk for developing breast cancer of 20% or higher

  • Yearly CBE starting age 20;
  • Annual mammogram beginning age 30;
  • Annual MRI beginning age 30;
  • Practice breast self awareness (SBE optional).


Again, get your screening mammograms, choose moderation over excess and most importantly, enjoy your life!


Dr. Marla Anderson is a board certified practicing general surgeon.  She is Chief of the Department of General Surgery at Kaiser Permanente’s San Rafael campus.  Dr. Anderson attended medical school at Northwestern University Medical School and completed her general surgery residency at Northwestern Memorial Hospital in Chicago.  Dr. Anderson holds a special place in her heart for her patients, as well as all women, diagnosed with and undergoing treatment for breast cancer.