Who should be screened for breast cancer

Screening for breast cancer is recommended every 2 years for the asymptomatic average risk population from age 50 until age 69.1

It is also recommended that all women be aware of how their breasts normally look and feel and promptly report any new or unusual changes to their GP.

Examples of changes include:

  • lumps
  • nipple changes
  • nipple discharge
  • change in skin colour
  • pain in a breast.

Increasing participation

A review of strategies for increasing participation found five strategies that may increase participation in community breast screening programs.1

  • Letter of invitation
  • Mailed educational material
  • Letter of invitation plus phone call
  • Phone call
  • Training activities plus direct reminders

Family history can be assessed using an online tool from Cancer Australia.

Early detection is better 

Population-based screening using mammography is the best early detection method available for reducing deaths from breast cancer. Evidence of the benefit is strongest for women aged 50–69 years. For all women there is a chance that mammography will either miss breast cancer (false negative) or detect a change not caused by breast cancer (false positive). The chance of a false negative or false positive result is higher in younger women because their breast tissue is denser, making it more difficult to detect changes.

Women aged 40–49 years

Women aged 40–49 years are eligible for free 2-yearly screening mammograms through BreastScreen Australia, although they are not targeted by the program. In deciding whether to attend for screening mammography, women in this age group should balance the potential benefits and downsides for them, considering the evidence that screening mammography is less effective for women in this age group than for older women. Generally, breasts become less dense as women get older, particularly after menopause, which is why mammograms become more effective as women get closer to age 50 years. Mammographic screening is not recommended for women aged <40 years because the reduced accuracy of mammography produces a high risk of false positive and false negative results.

Women aged ≥70 years

Women aged ≥70 years are eligible for free 2-yearly screening mammograms through BreastScreen Australia, although they are not targeted by the program because there is limited evidence available from randomised controlled trials about the benefits of screening them. Women in this age group should balance the potential benefits and downsides of screening, considering their general health and whether they have other diseases or conditions.

RACGP – Breast cancer detection by risk1
Average or slightly increased risk Moderately increased risk Potentially high risk
Who

>95% of women

About 1.5 times the population average

No confirmed family history of breast cancer

One first-degree relative diagnosed with breast cancer at age 50 years or older

One second-degree relative diagnosed with breast cancer at any age

Two second-degree relatives on the same side of the family diagnosed with breast cancer at age 50 years or older

Two first- or second-degree relatives diagnosed with breast cancer, at age 50 years or older, but on different sides (i.e. on each side) of the family

As a group, risk of breast cancer up to age 75 years is between 1:11 and 1:8.

<4% of the female population

About 1.5–3 times the population average

One first-degree relative diagnosed with breast cancer before the age of 50 (without the additional features of the potentially high-risk group)

Two first-degree relatives, on the same side of the family, diagnosed with breast cancer (without the additional features of the potentially high-risk group)

Two second-degree relatives, on the same side of the family, diagnosed with breast cancer, at least one before age 50 years (without the additional features of the potentially high-risk group)

As a group, the relative risk of breast cancer up to age 75 years is between 1:8 and 1:4.

<1% of the female population

For specific risk populations and interventions please refer to the RACGP Red Book.
What to do

Clarify risk using the Familial Risk Assessment – Breast and Ovarian Cancer tool

Mammogram

Breast awareness

Clarify risk using the Familial Risk Assessment – Breast and Ovarian Cancer tool

Mammogram

Breast awareness

Consider referral to or consultation with a family cancer clinic for further assessment and management plan
For specific risk populations and interventions please refer to the RACGP Red Book.
How often Every 2 years from age 50–69 years

At least every 2 years from age 50–69 years

Annual mammograms from age 40 may be recommended if the woman has a first-degree relative < age 50 years diagnosed with breast cancer

For specific risk populations and interventions please refer to the RACGP Red Book.
Table and related information taken from the RACGP Red Book.
References
  1. Guidelines for preventive activities in general practice (The Red Book) 8th Edition. Melbourne: The Royal Australian College of General Practitioners, 2012. http://www.racgp.org.au/your-practice/guidelines/redbook/ (accessed 8 January 2013).