Breast Cancer Screening (BCS-E)

The percentage of persons 40–74 years of age who were recommended for routine breast cancer screening and had a mammogram to screen for breast cancer.

Why It Matters

Breast cancer is the second most common type of cancer among American women. There are over 4 million women estimated to be living with breast cancer. Advancing age is the primary risk factor for breast cancer, with the median age of diagnosis at 62 years ¹.

Mammograms are the best method to detect early breast cancer before it is big enough to feel or cause symptoms and is easier to treat. Detecting early breast cancer via mammography can provide people with a greater range of treatment options, such as less aggressive surgery such as a lumpmastectomy, and less toxic chemotherapy ^{2 3}.

Conversely, mammography can lead people to be diagnosed and treated for noninvasive or invasive breast cancer that would otherwise not have become a health threat during their lifetime. It could produce false-positive results, which may lead to invasive follow-up examinations like biopsies and cause women to experience anxiety, or false-negative results in which cancer is missed. Mammography exposes people to radiation, though the risk of radiation-induced breast cancer has been found to be minimal ⁴.

Given the benefits and risks of mammography, major clinical organizations have developed guidelines on the attributes of screening programs that produce the highest net benefit for women. The U.S. Preventive Services Task Force (USPSTF) recommends biennial screening mammography for women 40-74 ⁴. The American College of Physicians recommend that women ages 50–74 should have biennial screening ⁵. The American Cancer Society recommends that women 40–44 should have a choice about whether to have annual mammograms, and recommends annual mammograms start by age 45 ³. The American College of Obstetricians and Gynecologists, the National Comprehensive Cancer Network (NCCN) and the American College of Radiology (ACR) recommend annual mammograms for women ages 40 and older ^{6 7 8}.

Additional guidelines from the University of California San Francisco Center of Excellence for Transgender Health ⁹, World Professional Association for Transgender Health ¹⁰ and The Fenway Institute ¹¹ recommend breast cancer screening for transgender and gender-diverse patients assigned female at birth or with breasts from natal puberty, as well as transgender and gender-diverse patients assigned male at birth with at least 5–10 years of exposure to gender-affirming estrogen therapy, excluding those with bilateral mastectomy or chest reconstruction.

Digital breast tomosynthesis (DBT), a newer mammography technology, uses three-dimensional (3D) images. The USPSTF states DBT and traditional digital mammography are effective primary screening modalities for women at average risk of breast cancer. Screening for women at higher risk for breast cancer was not within the scope of USPSTF recommendations ⁴. The NCCN and the ACR recommend using conventional mammography or DBT for screening women at low, intermediate or high risk for breast cancer ^{7 8}.

Studies have found that DBT may reduce false positives and detect slightly more invasive cancers than conventional mammography alone. When compared to digital mammography, DBT did not show a significant difference in the amount of false positives. The earliest-approved DBT method that involves a 3D imaging procedure and a conventional mammography procedure has about twice the radiation dose than conventional mammography alone. A newer DBT method uses one imaging procedure and software to reconstruct images; it delivers radiation dose levels similar to conventional digital mammography. Given these concerns, experts in the field emphasize the need for engaging patients in shared decision making when considering mammography screening ⁷.

Historical Results – National Averages