Living Reference Work Entry

Handbook of Gynecology

pp 1-8

Date: Latest Version

Breast Cancer Screening

  • Heather R MacdonaldAffiliated withKeck School of Medicine, University of Southern California Email author 

Abstract

It is expected in 2016 246,660 women in the United States will be newly diagnosed with breast cancer and 40,450 women will die of the disease. The purpose of breast cancer screening is to identify preclinical disease in asymptomatic women as breast cancer survival is improved with early detection. Digital mammography remains the mainstay of breast cancer screening. Tomosynthesis (3-D mammogram) has improved sensitivity with fewer false-positive studies, especially in women with dense breasts. Concerns have been raised about harms of false positives (repeat imaging and/or biopsies for benign findings), overdiagnosis of clinically insignificant breast cancers, and overtreatment. Thus, breast cancer screening recommendations range from initiation of screening at 40 years and performed annually to initiation at 50 years and performed biannually.

All guidelines recommend cancer risk assessment with a physician and development of an individualized screening program.

Women with the strongest risk factor for breast cancer, including personal history of cancer or atypical breast biopsy or family history of breast cancer, should undergo annual screening mammography. Women known to carry a familial breast cancer gene or at a lifetime risk of breast cancer greater than 20% should undergo annual breast MRI in addition to annual mammogram. Screening should conclude when a woman’s life expectancy is less than 5 years.

Keywords

Breast cancer risk factors Familial breast cancer syndromes Breast cancer risk assessment Mammography Breast MRI Tomosynthesis BIRADS score