Table 4:

National and international guidelines on breast cancer screening

Organization	Recommendations
Canadian Task Force on Preventive Health Care (current guideline, 2018)	Recommendations apply to breast cancer screening for women aged 40 to 74 years who are not at increased risk of breast cancer: Mammography: For women aged 40 to 49 years, we recommend not screening with mammography; the decision to undergo screening is conditional on the relative value a woman places on possible benefits and harms from screening (conditional recommendation; low-certainty evidence). For women aged 50 to 69 years, we recommend screening with mammography every 2 to 3 years; the decision to undergo screening is conditional on the relative value that a woman places on possible benefits and harms from screening (conditional recommendation; very low-certainty evidence). For women aged 70 to 74 years, we recommend screening with mammography every 2 to 3 years; the decision to undergo screening is conditional on the relative value that a woman places on possible benefits and harms from screening (conditional recommendation; very low-certainty evidence). Other screening modalities: Recommendations on using screening modalities other than mammography for breast cancer screening: We recommend not using MRI, tomosynthesis or ultrasound to screen for breast cancer in women who are not at increased risk (strong recommendation; no evidence). We recommend not performing clinical breast examinations to screen for breast cancer (conditional recommendation; no evidence). We recommend not advising women to practise breast self-examination to screen for breast cancer (conditional recommendation; low-certainty evidence).
Canadian Task Force on Preventive Health Care (2011)5	Recommendations apply to women aged 40 to 74 years at average risk of breast cancer: Mammography: For women aged 40–49 years, we recommend not routinely screening with mammography (weak recommendation; moderate-quality evidence). For women aged 50–69 years, we recommend routinely screening with mammography every 2 to 3 years (weak recommendation; moderate-quality evidence). For women aged 70–74 years, we recommend routinely screening with mammography every 2 to 3 years (weak recommendation; low-quality evidence). MRI: We recommend not routinely screening with MRI scans (weak recommendation; no evidence). Clinical breast examination: We recommend not routinely performing clinical breast examinations alone or in conjunction with mammography to screen for breast cancer (weak recommendation; low-quality evidence). Breast self-examination: We recommend not advising women to routinely practise breast self-examination (weak recommendation; moderate-quality evidence).
United States Preventive Services Task Force (2016)88	Biennial screening mammography for women aged 50 to 74 years (Grade B recommendation). The decision to start screening mammography in women before age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between 40 and 49 years of age (Grade C recommendation). For women aged 75 years or older, current evidence is insufficient to assess the balance of benefits and harms of screening mammography (I statement). For all women, current evidence is insufficient to assess the benefits and harms of digital breast tomosynthesis as a primary screening method for breast cancer (I statement). For women with dense breasts, current evidence is insufficient to assess the balance of benefits and harms of adjunctive screening for breast cancer following a negative mammogram using breast ultrasonography, MRI, digital breast tomosynthesis, or other methods in women identified to have dense breasts on an otherwise negative screening mammogram (I statement).
American Cancer Society (2015)89	Women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 years (strong recommendation). Women aged 45 to 54 years should be screened annually, transitioning to biennial screening at 55 years of age with the option to continue annual screening (qualified recommendations). Women between the ages of 40 and 44 years should have the opportunity to begin annual screening (qualified recommendation). Healthy women should continue screening mammography as long as they have a life expectancy of 10 years or longer (qualified recommendation). The American Cancer Society does not recommend clinical breast examination for breast cancer screening among average-risk women at any age (qualified recommendation).
UK National Health Service Breast Screening Programme (2015)90	The UK National Screening Committee recommends that all eligible women aged 50 to 70 years be invited to breast cancer screening every 3 years. Eligible women, aged 50 to 70, receive an invitation letter explaining the program, as well as benefits and risks of breast screening: Women do not always receive an invitation when they turn 50. They can expect their invitation within 3 years of their 50th birthday. Women cannot walk in and request breast screening unless they are older than 70, when they can request screening every 3 years.
Cancer Australia (2015)91	It is recommended that women of all ages, and regardless of whether they attend mammographic screening, are aware of how their breasts normally look and feel and report any new or unusual changes promptly to their general practitioner. No one method for women to use when checking their breasts is recommended over another. It is recommended, to reduce the risk of death from breast cancer, that women aged 50–74 years attend the BreastScreen Australia Program for free 2-yearly screening mammograms, having considered the benefits and downsides. Mammographic screening is not recommended for women younger than 40 years of age. Women aged 40–49 years and 75 years and older are eligible to receive free screening mammograms through the BreastScreen Australia Program, but they do not receive an invitation to attend. In deciding whether to attend for screening mammography, women in these age groups should balance the potential benefits and downsides for them. For women of all ages who are at increased risk of developing breast cancer, it is recommended that an individualized surveillance program be developed in consultation with the woman’s general practitioner or specialist.

Note: MRI = magnetic resonance imaging.