Recommendations and Rationale

Screening for Breast Cancer

U.S. Preventive Services Task Force (USPSTF)

This statement summarizes the current U.S. Preventive Services Task Force (USPSTF) recommendation on screening for breast cancer and the supporting scientific evidence, and updates the 1996 recommendation contained in the Guide to Clinical Preventive Services, Second Edition¹.

Contents

Clinical Considerations
Scientific Evidence
Recommendations of Others
References and Notes
Members of the Task Force
Contact the Task Force
Available Products

Clinical Considerations

• The precise age at which the benefits from screening mammography justify the potential harms is a subjective judgment and should take into account patient preferences. Clinicians should inform women about the potential benefits (reduced chance of dying from breast cancer), potential harms (e.g., false-positive results, unnecessary biopsies), and limitations of the test that apply to women their age. Clinicians should tell women that the balance of benefits and potential harms of mammography improves with increasing age for women between the ages of 40 and 70.
• Women who are at increased risk for breast cancer (e.g., those with a family history of breast cancer in a mother or sister, a previous breast biopsy revealing atypical hyperplasia, or first childbirth after age 30) are more likely to benefit from regular mammography than women at lower risk. The recommendation for women to begin routine screening in their 40s is strengthened by a family history of breast cancer having been diagnosed before menopause.
• The USPSTF did not examine whether women should be screened for genetic mutations (e.g., BRCA1 and BRCA2) that increase the risk for developing breast cancer, or whether women with genetic mutations might benefit from earlier or more frequent screening for breast cancer.
• In the trials that demonstrated the effectiveness of mammography in lowering breast cancer mortality, screening was performed every 12-33 months. For women aged 50 and older, there is little evidence to suggest that annual mammography is more effective than mammography done every other year. For women aged 40-49, available trials also have not reported a clear advantage of annual mammography over biennial mammography. Nevertheless, some experts recommend annual mammography based on the lower sensitivity of the test and on evidence that tumors grow more rapidly in this age group.
• The precise age at which to discontinue screening mammography is uncertain. Only two randomized controlled trials enrolled women older than 69 and no trials enrolled women older than 74. Older women face a higher probability of developing and dying from breast cancer but also have a greater chance of dying from other causes. Women with comorbid conditions that limit their life expectancy are unlikely to benefit from screening.
• Clinicians should refer patients to mammography screening centers with proper accreditation and quality assurance standards to ensure accurate imaging and radiographic interpretation. Clinicians should adopt office systems to ensure timely and adequate followup of abnormal results. A listing of accredited facilities is available at http://www.fda.gov/cdrh/mammography/certified.html.
• Clinicians who advise women to perform BSE or who perform routine CBE to screen for breast cancer should understand that there is currently insufficient evidence to determine whether these practices affect breast cancer mortality, and that they are likely to increase the incidence of clinical assessments and biopsies.

Return to Contents

Scientific Evidence

Epidemiology and Clinical Consequences

Breast cancer is the most common non-skin malignancy among women in the United States and second only to lung cancer as a cause of cancer-related death. In 2001, an estimated 192,200 new cases of breast cancer were diagnosed in American women, and 40,200 women died of the disease.⁵ The risk for developing breast cancer increases with age beginning in the fourth decade of life. The probability of developing invasive breast cancer over the next 10 years is 0.4 percent for women aged 30-39, 1.5 percent for women aged 40-49, 2.8 percent for women aged 50-59, and 3.6 percent for women aged 60-69.⁵ Individual factors other than age that increase the risk for developing breast cancer include family history or a personal history of breast cancer, biopsy-confirmed atypical hyperplasia, and having a first child after age 30.⁶

Accuracy and Reliability of Screening Tests

The USPSTF examined the test characteristics of mammography, CBE, and BSE. Precise estimates of sensitivity and specificity of screening are made more difficult by the varied criterion standards in available studies. Estimating the predictive value of positive and negative tests is also difficult because studies have been conducted on populations with a widely varying prevalence of breast cancer.

Mammography

Estimates of the sensitivity of mammography vary with the methods used to calculate it.² In a good quality systematic review, the first round of mammography detected 77 percent to 95 percent of cancers diagnosed over the following year, but only 56 percent to 86 percent of cancers diagnosed over the next 2 years.^3,7 Sensitivity is lower among women who are younger than 50, have denser breasts, or are taking hormone replacement therapy.³

In screening trials, the false-positive rate of the initial round of mammography was 3 percent to 6 percent (i.e., specificity 94 percent to 97 percent).³ Specificity is increased with a shorter screening interval and the availability of prior mammograms.³ In a large study in a health maintenance organization, the rate of false-positive mammograms (those requiring some additional followup) was higher in women aged 40-59 (7 percent to 8 percent) than in women aged 60-79 (4 percent to 5 percent).⁸

The probability that an abnormal mammogram is due to cancer increases with age. A large study in Northern California estimated positive predictive values for abnormal mammograms at 2 percent to 4 percent among women aged 40-49, 5 percent to 9 percent among women aged 50-59, and 7 percent to 19 percent among women aged 60 and older.^3,9 Positive predictive values were also higher among women with a family history of breast cancer in two studies.³

Clinical Breast Examination

In a recent good quality review of data from clinical trials, the sensitivity of CBE ranged from 40 percent to 69 percent, specificity from 86 percent to 99 percent, and positive predictive value from 4 percent to 50 percent, using mammography and interval cancer as the criterion standard.¹⁰ In a large community study, only 4 percent of women with an abnormal CBE were subsequently diagnosed with cancer.¹¹

Breast Self-examination

The accuracy of BSE is largely unknown. Available evidence shows sensitivity ranging from 26 percent to 41 percent compared with CBE and mammography.³ Specificity of BSE is largely unknown.

Effectiveness of Early Detection

The USPSTF reviewed eight randomized controlled trials (RCTs) of mammography (four of mammography alone and four of mammography plus CBE) that have reported results with 11-20 years of followup.^4,12-21 The USPSTF found important methodological limitations in each trial, but rated only one trial as "poor" based on established criteria used by the USPSTF to evaluate the quality of evidence for screening tests.²² The most serious problems concerned the assembly and maintenance of comparable groups, methods for ascertaining outcomes, and generalizability to routine practice. The USPSTF concluded that the flaws were problematic but unlikely to negate the reasonably consistent and significant mortality reductions observed in these trials.

Imperfections in these mammography trials have been recognized and discussed in the literature and by the original investigators for many years. Recently, a 2001 Cochrane Collaboration review²³ of the same trials concluded that six of the eight trials were "flawed" or of "poor quality" and that the pooled results from the remaining two better-quality trials did not support a benefit from mammography. Although the USPSTF was concerned about many (but not all) of the flaws identified in the Cochrane review, it did not consider the presence of flaws sufficient reason in itself for rejecting trial results. Instead, it examined whether observed mortality reductions in the trials were likely to be explained by the biases potentially introduced by such flaws. Studies rated to be of "fair" quality by the USPSTF contained flaws that were considered unlikely to account for observed benefits (or lack of benefits).

The trials^4,12-21 reported mortality reductions ranging from no significant effect to a 32-percent reduction in breast cancer mortality. The meta-analysis performed for the USPSTF on the most current published data found that the pooled effect size of the combined trials was sizable and statistically significant. After excluding data from one trial rated as poor quality by the USPSTF,¹⁷ the summary relative risk (RR) of breast cancer death among women of all ages randomized to screening in the remaining seven trials was 0.84 (95 percent CI, 0.77-0.91).

Earlier subgroup analyses from these mammography trials raised questions about whether screening is effective in women younger than 50. Seven trials enrolled women aged 40-49. Six of these were rated by the USPSTF to be of at least "fair" quality, but only one of these was designed to specifically address the benefits of screening in this age group: it reported no reduction in breast cancer mortality with annual mammography and CBE.^18,20 Of the remaining five fair-quality trials that included women younger than 50, one trial has reported significant mortality reduction with screening in this age group,^4,13 three have reported non-significant mortality reductions,^4,12,15,16 and one found no benefit.¹⁴ In a meta-analysis performed for the USPSTF pooling results for women aged 40-49 in the six fair-quality trials, the summary relative risk of breast cancer mortality was 0.85 (95 percent CI, 0.73-0.99) among screened women after 13 years of observation.² These results are similar to prior meta-analyses based on older data.

Because these data represent a subgroup analysis of trials not designed to test the benefits of beginning screening at a specific age, questions remain about the additional benefits of beginning screening before age 50. On average, the time until mortality benefits begin to be observed in these trials is longer in women younger than 50 than in older women (8 years vs 4 to 6 years) and some of the observed benefits could be due to screening after age 50.^3,4 Analyses of individual studies suggest that at least some of the mortality reduction is due to early detection of tumors before age 50, but definitive estimates of the proportion of benefits due to early screening cannot be made.^3,24

Clinical Breast Examination

No study has compared CBE to no screening. The reductions in breast cancer mortality in studies using mammography alone are comparable to those using mammography plus CBE.³

Breast Self-Examination

The role of BSE in reducing breast cancer mortality has been evaluated in one Chinese²⁵ and one Russian²⁶ RCT and one non-randomized controlled trial of BSE education in the United Kingdom.²⁷ None of the three trials has demonstrated a reduction in breast cancer mortality or significant improvements in the number or stage of cancers detected, with followup ranging from 5 to 14 years; followup is continuing in one trial that observed a slight non-significant reduction in mortality in the BSE group at 9 years.²⁶ In a good-quality nested case-control analysis from a Canadian screening study, the overall practice of BSE was not associated with a reduction in mortality.²⁸ Although none of these studies provides support for BSE, the USPSTF concluded that these studies did not exclude a possible benefit, due to their limited duration of followup and questions about whether results from other countries are generalizable to women in North America.

When To Stop Screening

Although there are no trial data directly evaluating screening in women older than 74, two RCTs suggest benefits among women enrolled in screening trials up to ages 70 and 74.^15,16 Because risk for breast cancer is high after age 70, the benefits of mammography could be important. However, this is offset by the fact that some older women (especially the very old and those with comorbid illness) will die from other causes before they observe any benefits from early detection.

Screening Interval

In clinical trials, mortality reductions occurred in programs with screening intervals ranging from 12-33 months, with no clear difference due to interval.³ Data suggest that breast cancer grows more rapidly in women younger than 50, and the sensitivity of mammography is lower in this age group; thus, shorter screening intervals have been advocated for women aged 40-49. Among the trials showing or suggesting a benefit of screening in women younger than 50, screening intervals that ranged from 12-33 months appeared to achieve comparable results, providing no direct evidence of incremental benefits over annual screening.³

Potential Harms of Screening

Similar to other cancer screening tests, the large majority (80 percent to 90 percent) of abnormal screening mammograms or CBEs are false-positives.³ These may require followup testing or invasive procedures such as breast biopsy to resolve the diagnosis, and can result in anxiety, inconvenience, discomfort, and additional medical expenses.³ In one large community study, 6.5 percent of screening mammograms required some additional followup and, over a 10-year period, 23 percent of all women had experienced at least one abnormal mammogram.⁸ The cumulative risk for a false-positive result after 10 mammograms was estimated to be 49 percent.⁸ The proportion of false-positive results that lead to biopsy varies substantially in different settings.²⁹ In screening trials, 1 percent to 6 percent of all women screened underwent biopsy, and the proportion of biopsies that revealed cancer ranged from 12 percent to 78 percent.³ In two RCTs, BSE education resulted in a nearly two-fold increase in false-positive results, physician visits, and biopsies for benign disease.^25,26

The consequences of false-positive mammograms are uncertain. Most, but not all, studies report increased anxiety from an abnormal mammogram.² At the same time, some studies report that women in the United States may be willing to accept a relatively high number of false-positive results in the population in return for the benefits of mammography.^2,30 Studies do not indicate that false-positive results diminish adherence to subsequent screening.³

False-negatives also occur with mammograms and CBE. Although false-negative results might provide false reassurance, the USPSTF found no data indicating these led to further delays in diagnosis.³

Some experts view the over-diagnosis and treatment of ductal carcinoma in situ (DCIS) as a potential adverse consequence of mammography. Although the natural history of DCIS is variable, many women in the United States are treated aggressively with mastectomy or lumpectomy and radiation.² Given the dramatic increase in the incidence of DCIS in the past two decades (750 percent) and autopsy series suggesting that there is a significant pool of DCIS among women who die of other causes,³ screening may be increasing the number of women undergoing treatment for lesions that might not pose a threat to their health.

A final potential concern about mammography is radiation-induced breast cancer, but there are few data to directly assess this risk. A 1997 review, using risk estimates provided by the Biological Effects of Ionizing Radiation report of the National Academy of Sciences, estimated that annual mammography of 100,000 women for 10 consecutive years beginning at age 40 would result in up to 8 radiation-induced breast cancer deaths.³¹

Return to Contents

Recommendations of Others

Nearly all North American organizations support mammography screening, although groups vary in the recommended age to begin screening, the interval for screening, and the role of CBE.

The American Medical Association (AMA),³² the American College of Obstetricians and Gynecologists (ACOG),³³ the American College of Radiology (ACR),³⁴ and the American Cancer Society (ACS),³⁵ all support screening with mammography and CBE beginning at age 40. The Canadian Task Force on Preventive Health Care (CTFPHC),³⁶ the American Academy of Family Physicians (AAFP),³⁷ and the American College of Preventive Medicine (ACPM)³⁸ recommend beginning mammography for average-risk women at age 50. AAFP and ACPM recommend that mammography in high-risk women begin at age 40, and AAFP recommends that all women aged 40-49 be counseled about the risks and benefits of mammography before making decisions about screening.^37,38

A 1997 Consensus Development Panel convened by the National Institutes of Health concluded that the evidence was insufficient to determine the benefits of mammography among women aged 40-49. This panel recommended that women aged 40-49 should be counseled about potential benefits and harms before making decisions about mammography.³⁹ In 2001, the CTFPHC concluded there was insufficient evidence to recommend for or against mammography in women 40-49.⁴⁰

Organizations differ on their recommendations for the appropriate interval for mammography. Annual mammography is recommended by AMA, ACR, and ACS.32,34,35 Mammography every 1-2 years is recommended by AAFP, ACPM, and the CTFPHC.^36-38 ACOG recommends annual mammography every 1-2 years for women aged 40-49 and annually for women aged 50 and older.³³

In their 2001 report, the Canadian Task Force on Preventive Health Services recommends against teaching BSE to women aged 40-69.⁴¹ The AMA, ACOG, ACS, and AAFP support teaching BSE.^32,33,35,37

Return to Contents

References and Notes

References

1. U.S. Preventive Services Task Force. Guide to Clinical Preventive Services, Second Edition. Washington, DC: Office of Disease Prevention and Health Promotion; 1996.

2. Humphrey LL, Helfand M, Chan BKS. Breast cancer screening: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2002;137:347-60.

3. Humphrey LL, Chan BKS, Detlefsen S, Helfand M. Screening for Breast Cancer. Systematic Evidence Review No. 15 (Prepared by the Oregon Health & Science University Evidence-based Practice Center under Contract No. 290-97-0018). Rockville, MD: Agency for Healthcare Research and Quality. September 2002. (Available at: http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat3.chapter.27509).

4. Nystrom L, Andersson I, Bjurstam N, Frisell J, Nordenskjöld B, Rutqvist LE. Long-term effects of mammography screening: updated overview of the Swedish randomized trials. Lancet 2002;359(9310):909-19.

5. American Cancer Society. Cancer facts and figures, 2001-2002. Atlanta, Georgia: American Cancer Society. Available at: http://www.cancer.org. Accessed February 18, 2002.

6. National Cancer Institute. Surveillance, Epidemiology, and End Results Program 1995-1997. Available at: http://www.nci.nih.gov. Accessed February 18, 2002.

7. Mushlin AI, Kouides RW, Shapiro DE. Estimating the accuracy of screening mammography: a meta-analysis. Am J Prev Med 1998;14(2):143-53.

8. 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(16):1089-96.

9. Kerlikowske K, Carney PA, Geller B, et al. Performance of screening mammography among women with and without a first-degree relative with breast cancer. Ann Intern Med 2000;133(11):855-63.

10. Barton MB, Harris R, Fletcher SW. Does this patient have breast cancer? The screening clinical breast examination: should it be done? How? JAMA 1999;282(13):1270-80.

11. 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(12):971-6.

12. Shapiro S. Periodic screening for breast cancer: the HIP Randomized Controlled Trial Health Insurance Plan. J Natl Cancer Inst Monogr 1997;22:27-30.

13. Bjurstam N, Bjorneld L, Duffy SW, et al. The Gothenburg breast screening trial: first results on mortality, incidence, and mode of detection for women ages 39-49 years at randomization. Cancer 1997;80(11):2091-9.

14. Frisell J, Lidbrink E, Hellstrom L, Rutqvist LE. Followup after 11 years: update of mortality results in the Stockholm mammographic screening trial. Breast Cancer Research & Treatment 1997;45:263-70.

15. Andersson I, Janzon L. Reduced breast cancer mortality in women under age 50: updated results from the Malmö Mammographic Screening Program. J Natl Cancer Inst Monogr 1997;22:63-7.

16. Tabar L, Vitak B, Chen HH, et al. The Swedish Two-County Trial twenty years later: updated mortality results and new insights from long-term followup. Radiol Clin North Am 2000;38(4):625-51.

17. Alexander FE, Anderson TJ, Brown HK, et al. 14 years of followup from the Edinburgh randomised trial of breast-cancer screening. Lancet 1999;353(9168):1903-8.

18. Miller AB, Baines CJ, To T, Wall C. Canadian National Breast Screening Study: 1. Breast cancer detection and death rates among women aged 40 to 49 years [published erratum appears in Can Med Assoc J 1993;148(5):718]. CMAJ 1992;147:1459-76.

19. 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 [published erratum appears in Can Med Assoc J 1993;148(5):718]. CMAJ 1992;147:1477-88.

20. Miller AB, To T, Baines CJ, Wall C. The Canadian National Breast Screening Study: update on breast cancer mortality. J Natl Cancer Inst Monogr 1997;22:37-41.

21. Nystrom L, Rutqvist LE, Wall S, et al. Breast cancer screening with mammography: overview of Swedish randomized trials. Lancet 1993;341(8851):973-8.

22. Harris RP, Helfand M, Woolf SH, et al. Methods of the third U.S. Preventive Services Task Force. Am J Prev Med 2001;20(suppl 3):21-35.

23. Olsen O, Gøtzsche PC. Screening for breast cancer with mammography (Cochrane Review). In: The Cochrane Library, Issue 3 2002. Oxford: Update Software. Available at: http://www.cochrane.org/cochrane/revabstr/ab001877.htm. Accessed August 14, 2002.

24. Cox B. Variation in the effectiveness of breast screening by year of followup. J Natl Cancer Inst Monogr 1997;22:69-72.

25. Thomas DB, Gao DL, Self SG, et al. Randomized trial of breast self-examination in Shanghai: methodology and preliminary results. J Natl Cancer Inst 1997;89(5):355-65.

26. Semiglazov VF, Moiseenko VM, Manikhas AG, et al. Interim results of a prospective randomized study of self-examination for early detection of breast cancer. Russia/St.Petersburg/World Health Organization. Vopr Onkol 1999;45(3):265-71.

27. UK Breast Cancer Detection Working Group. 16-year mortality from breast cancer in the UK trial of early detection of breast cancer. Lancet 1999;353(9168):1909-14.

28. 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(9):1205-12.

29. Fletcher SW, Harris RP, Gonzalez JJ, et al. Increasing mammography utilization: a controlled study. J Natl Cancer Inst 1993;85:112-20.

30. Schwartz LM, Woloshin S, Sox HC, Fischhoff B, Welch HG. U.S. women's attitudes to false positive mammography results and detection of ductal carcinoma in situ: cross sectional survey. Br Med J 2000;320(7250):1635-40.

31. Feig SA, Hendrick RE. Radiation risk from screening mammography of women aged 40-49 years. J Natl Cancer Inst Monogr 1997(22):119-24.

32. American Medical Association. Report 16 of the Council on Scientific Affairs (A-99). Mammographic Screening for Asymptomatic Women. June 1999. Available at: http://www.ama-assn.org/ama/pub/article/2036-2346.html. Accessed January 2002.

33. American College of Obstetricians and Gynecologists. Primary and preventive care: periodic assessments. ACOG Committee Opinion 246. Washington, DC: ACOG, 2000.

34. Feig SA, D'Orsi CJ, Hendrick RE, et al. American College of Radiology guidelines for breast cancer screening. Am J Roentgenol 1998;171(1):29-33.

35. ACS guidelines for the early detection of breast cancer: update 1997. CA Cancer J Clin 1997;47(3):150-3.

36. Canadian Task Force on the Periodic Health Examination. Ottawa (Canada): Health Canada; 1994:788-795 (reaffirmed by the Canadian Task Force on the Periodic Health Examination 1999). Available at: http://www.ctfphc.org/index.html. Accessed February 18, 2002.

37. Periodic Health Examinations: Summary of AAFP Policy Recommendations & Age Charts. Available at: http://www.aafp.org/exam. Accessed January 2002.

38. Ferrini R, Mannino E, Ramsdell E, Hill L. Screening mammography for breast cancer: American College of Preventive Medicine practice policy statement. Am J Prev Med 1996;12(5):340-1.

39. Breast Cancer Screening for Women Ages 40-49. NIH Consensus Statement Online 1997 Jan 21-23; 15(1):1-35. Available at: http://odp.od.nih.gov/consensus/cons/103/103_statement.htm. Accessed December 12, 2001.

40. Jolie Ringash and the Canadian Task Force on Preventive Health Care. Preventive health care, 2001 update: screening mammography among women aged 40-49 years at average risk of breast cancer. Available at: http://www.ctfphc.org). Accessed August 15, 2002.

41. Nancy Baxter and the 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(3):1837-46.

Copyright Information

This document is in the public domain within the United States. For information on reprinting, contact Randie Siegel, Director, Division of Printing and Electronic Publishing, Agency for Healthcare Research and Quality, Suite 501, 2101 East Jefferson Street, Rockville, MD 20852. Requests for linking or to incorporate content in electronic resources should be sent to: info@ahrq.gov.

Recommendations made by the USPSTF are independent of the U.S. Government. They should not be construed as an official position of AHRQ or the U.S. Department of Health and Human Services.

Source: This recommendation first appeared in Ann Intern Med 2002;137(1):344-6.

Return to Contents

Members of the Task Force

Members of the U.S. Preventive Services Task Force are Alfred O. Berg, M.D., M.P.H., Chair, USPSTF (Professor and Chair, Department of Family Medicine, University of Washington, Seattle, WA); Janet D. Allan, Ph.D., R.N., C.S., Vice-chair, USPSTF (Dean and Professor, School of Nursing, University of Texas Health Science Center, San Antonio, TX); Paul S. Frame, M.D. (Tri-County Family Medicine, Cohocton, NY, and Clinical Professor of Family Medicine, University of Rochester, Rochester, NY); Charles J. Homer, M.D., M.P.H. (Executive Director, National Initiative for Children's Healthcare Quality, Boston, MA); Mark S. Johnson, M.D., M.P.H. (Associate Professor of Clinical Family Medicine and Chairman Department of Family Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ); Jonathan D. Klein, M.D., M.P.H. (Associate Professor of Pediatrics and of Community and Preventive Medicine, University of Rochester School of Medicine, Rochester, NY), Tracy A. Lieu, M.D., M.P.H. (Associate Professor, Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, MA); Cynthia D. Mulrow, M.D., M.Sc. (Professor of Medicine, University of Texas Health Science Center, Audie L. Murphy Memorial Veterans Hospital, San Antonio, TX); C. Tracy Orleans, Ph.D. (Senior Scientist, The Robert Wood Johnson Foundation, Princeton, NJ); Jeffrey F. Peipert, M.D., M.P.H (Director of Research, Women and Infants' Hospital, Providence, RI); Nola J. Pender, Ph.D., R.N. (Professor and Associate Dean for Research, School of Nursing, University of Michigan, Ann Arbor, MI); Albert L. Siu, M.D., M.S.P.H (Professor of Medicine, Chief of Division of General Internal Medicine, and Medical Director of the Primary Care and Medical Services Care Center, Mount Sinai School of Medicine and The Mount Sinai Medical Center, New York, NY); Steven M. Teutsch, M.D., M.P.H. (Senior Director, Outcomes Research and Management, Merck & Company, Inc., West Point, PA); Carolyn Westhoff, M.D., M.Sc. (Associate Professor of Obstetrics, Gynecology and Public Health, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY); and Steven H. Woolf, M.D., M.P.H. (Professor of Family Medicine, Department of Family Practice, Virginia Commonwealth University, Richmond, VA).

Return to Contents

Contact the Task Force

Address correspondence to: Chair, U.S. Preventive Services Task Force; c/o Project Director, USPSTF; 540 Gaither Road; Rockville, MD 20850; E-mail: uspstf@ahrq.gov.

Return to Contents

Available Products

This recommendation and rationale statement, plus complete information on which this statement is based, including evidence tables and references, are available on the USPSTF Web site at http://www.preventiveservices.ahrq.gov.

The summary of the evidence and the recommendation statement are also available in print by subscription to the Guide to Clinical Preventive Services, Third Edition: Periodic Updates.

Return to Contents

Current as of February 2002

Internet Citation:

U.S. Preventive Services Task Force. Screening for Breast Cancer: Recommendations and Rationale. February 2002. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/3rduspstf/breastcancer/brcanrr.htm

USPSTF Topic Index
USPSTF Clinical Categories
U.S. Preventive Services Task Force (USPSTF)
Clinical Information
AHRQ Home Page