ACS Breast Cancer Screening Guidelines (2023)

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  • What are screening tests?
  • American Cancer Society screening recommendations for women at average breast cancer risk
  • American Cancer Society screening recommendations for women at high risk

Finding breast cancer early and getting state-of-the-art cancer treatment are two of the most important strategies for preventing deaths from breast cancer. Breast cancer that’s found early, when it’s small and has not spread, is easier to treat successfully. Getting regular screening tests is the most reliable way to find breast cancer early. The American Cancer Society has screening guidelines for women at average risk of breast cancer, and for those at high risk for breast cancer.

What are screening tests?

Screening refers to tests and exams used to find a disease in people who don’t have any symptoms. The goal of screening tests for breast cancer is to find it early, before it causes symptoms (like a lump in the breast that can be felt). Early detection means finding and diagnosing a disease earlier than if you’d waited for symptoms to start.

Breast cancers found during screening exams are more likely to be smaller and less likely to have spread outside the breast. The size of a breast cancer and how far it has spread are some of the most important factors in predicting the prognosis (outlook) of a woman with this disease.

American Cancer Society screening recommendations for women at average breast cancer risk

The COVID-19 pandemic initially resulted in most elective procedures being put on hold, leading to many people not getting screened for cancer. Learn how you can talk to your doctor and what steps you can take to plan, schedule, and get your regular cancer screenings in.

These guidelines are for women at average risk for breast cancer. For screening purposes, a woman is considered to be at average risk if she doesn’t have a personal history of breast cancer, a strong family history of breast cancer, or a genetic mutation known to increase risk of breast cancer (such as in a BRCA gene), and has not had chest radiation therapy before the age of 30. (See below for guidelines for women at high risk.)

  • Women between 40 and 44 have the option to start screening with a mammogram every year.
  • Women 45 to 54 should get mammograms every year.
  • Women 55 and older can switch to a mammogram every other year, or they can choose to continue yearly mammograms. Screening should continue as long as a woman is in good health and is expected to live at least 10 more years.
  • All women should understand what to expect when getting a mammogram for breast cancer screening – what the test can and cannot do.

Clinical breast exams are not recommended for breast cancer screening among average-risk women at any age.


Mammograms are low-dose x-rays of the breast. Regular mammograms can help find breast cancer at an early stage, when treatment is most likely to be successful. A mammogram can often find breast changes that could be cancer years before physical symptoms develop. Results from many decades of research clearly show that women who have regular mammograms are more likely to have breast cancer found earlier, are less likely to need aggressive treatments like surgery to remove the entire breast (mastectomy) and chemotherapy, and are more likely to be cured.

Mammograms are not perfect. They miss some breast cancers. And if something is found on a screening mammogram, a woman will likely need other tests (such as more mammograms or a breast ultrasound) to find out if it is cancer. There’s also a small chanceof being diagnosed with a cancer that never would have caused any problems had it not been found during screening. (This is called overdiagnosis.) It's important that women getting mammograms know what to expect and understand the benefits and limitations of screening.

2D vs. 3D mammograms

In recent years, a newer type of mammogram called digital breast tomosynthesis (commonly known as three-dimensional [3D] mammography) has become much more common, although it’s not available in all breast imaging centers.

Many studies have found that 3D mammography appears to lower the chance of being called back after screening for follow-up testing. It also appears to find more breast cancers, and several studies have shown it can be helpful in women with more dense breasts. A large study is now in progress to better compare outcomes between 3D mammograms and standard (2D) mammograms.

It should be noted that 3D mammograms often cost more than 2D mammograms, and this added cost may not be covered by insurance.

The American Cancer Society (ACS) breast cancer screening guidelines consider having had either a 2D or 3D mammogram as being in line with current screening recommendations. The ACS also believes that women should be able to choose between 2D and 3D mammography if they or their doctor believes one would be more appropriate, and that out-of-pocket costs should not be a barrier to having either one.

Clinical breast exam (CBE) and breast self-exam (BSE)

Research has not shown a clear benefit of regular physical breast exams done by either a health professional (clinical breast exams) or by women themselves (breast self-exams). There is very little evidence that these tests help find breast cancer early when women also get screening mammograms.Most often when breast cancer is detected because of symptoms (such as a lump in the breast), a woman discovers the symptom during usual activities such as bathing or dressing. Women should be familiar with how their breasts normally look and feel and should report any changes to a health care provider right away.

While the American Cancer Society does not recommend regular clinical breast exams or breast self-exams as part of a routine breast cancer screening schedule, this does not mean that these exams should never be done. In some situations, particularly for women at higher-than-average risk, for example, health care providers may still offer clinical breast exams, along with providing counseling about risk and early detection. And some women might still be more comfortable doing regular self-exams as a way to keep track of how their breasts look and feel. But it’s important to understand that there is very little evidence that doing these exams routinely is helpful for women at average risk of breast cancer.

American Cancer Society screening recommendations for women at high risk

Women who are at high risk for breast cancer based on certain factors should get a breast MRI and a mammogram every year, typically starting at age 30. This includes women who:

  • Have a lifetime risk of breast cancer of about 20% to 25% or greater, according to risk assessment tools that are based mainly on family history (see below)
  • Have a known BRCA1 or BRCA2 gene mutation(based on having had genetic testing)
  • Have a first-degree relative (parent, brother, sister, or child) with aBRCA1 or BRCA2gene mutation, and have not had genetic testing themselves
  • Had radiation therapy to the chest when they were between the ages of 10 and 30 years
  • Have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromes

The American Cancer Society recommends against MRI screening for women whose lifetime risk of breast cancer is less than 15%.

There’s not enough evidence to make a recommendation for or against yearly MRI screening for women who have a higher lifetime risk based on certain factors, such as:

  • Having a personal history of breast cancer, ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS), atypical ductal hyperplasia (ADH), or atypical lobular hyperplasia (ALH)
  • Having “extremely” or “heterogeneously” dense breasts as seen on a mammogram

If MRI is used, it should be in addition to, not instead of, a screening mammogram. This is because although an MRI is more likely to find cancer than a mammogram, it may still miss some cancers that a mammogram would find.

Most women at high risk should begin screening with MRI and mammograms when they are 30 and continue for as long as they are in good health. But this is a decision that should be madewith a woman's health care providers, taking into account her personal circumstances and preferences.

Tools used to assess breast cancer risk

Several risk assessment tools can help health professionals estimate a woman’s breast cancer risk. These tools give rough estimates of breast cancer risk, based on different combinations of risk factors and different data sets.

Because each of these tools uses different factors to estimate risk, they might give different risk estimates for the same woman. A women's risk estimates can also change over time.

Risk assessment tools that include family history in first-degree relatives (parents, siblings, and children) and second-degree relatives (such as aunts and cousins) on both sides of the family should be usedwith the ACS guidelines to decide if a woman should have MRI screening. The use of any of the risk assessment tools and its results should be discussed by a woman with her health care provider.

  1. Written by
  2. References

ACS Breast Cancer Screening Guidelines (1)

The American Cancer Society medical and editorial content team

Our team is made up of doctors andoncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Oeffinger KC, Fontham ET, Etzioni R, et al. Breast cancer screening for women at average risk: 2015 guideline update From the American Cancer Society. JAMA. 2015;314(15):1599-1614.

Saslow D, Boetes C, Burke W, et al. American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin. 2007 Mar-Apr;57(2):75-89.

Last Revised: January 14, 2022

American Cancer Society medical information is copyrightedmaterial. For reprint requests, please see our Content Usage Policy.


What is the ACS recommendation for breast cancer screening? ›

Women 45 to 54 should get mammograms every year. Women 55 and older can switch to a mammogram every other year, or they can choose to continue yearly mammograms. Screening should continue as long as a woman is in good health and is expected to live at least 10 more years.

Why does the ACS no longer recommend that females perform regular breast self examinations? ›

Why is a breast-self-exam no longer an option for women in the guidelines? Evidence does not show that regular breast self-exams help reduce deaths from breast cancer.

What is the difference between Uspstf and ACS breast cancer screening? ›

Both guidelines recommend primary HPV every 5 years or HPV/Pap co-test every 5 years or Pap test every 3 years, but differ by age group. ACS makes this recommendation for women ages 25 to 65, whereas USPSTF makes this recommendation for women ages 30 to 65.

What are the scores for breast screening? ›

How does the BI-RADS scoring system work? Doctors use the BI-RADS system to place abnormal findings into categories. The categories are from 0 to 6. Oftentimes, women 40 years and older receive scores ranging from 0 to 2, indicating normal results or that abnormal results are benign, or noncancerous.

What are the ACS guidelines for cancer prevention? ›

Along with avoiding tobacco products, staying at a healthy weight, staying active throughout life, and eating a healthy diet may greatly reduce a person's lifetime risk of developing or dying from cancer. These same behaviors are also linked with a lower risk of developing heart disease and diabetes.

At what age does the ACS recommend mammogram screening beginning? ›

The ACS provides a qualified recommendation that women between the ages of 40 years and 44 years should have the opportunity of initiating screening 23. The National Comprehensive Cancer Network recommends annual screening mammograms starting at age 40 years for all average-risk women 4.

Why is self breast exam no longer recommended? ›

Yes, most medical organizations no longer recommend routine self-breast exams, because research hasn't shown that self-breast exams improve cancer detection or outcomes. However, most organizations do recommend self-breast awareness or being familiar with the normal look and feel of your breasts.

Why is clinical breast exam no longer recommended? ›

The American Cancer Society no longer recommends CBEs or BSEs for women with an average risk for breast cancer because research has not associated them with clear benefits in settings where mammography screening is available and awareness is high.

Why shouldn't you do self breast exams? ›

Most medical organizations don't recommend routine breast self-exams as a part of breast cancer screening. That's because breast self-exams haven't been shown to be effective in detecting cancer or improving survival for women who have breast cancer.

What is the best screening for high risk breast cancer? ›

The ACS recommends that women at high risk should get a mammogram and breast MRI every year. ACS suggests that women at high risk begin their screening at age 30 or an age recommended by their health care provider and continue for as long as they are in good health.

How common is breast cancer ACS? ›

It is about 30% (or 1 in 3) of all new female cancers each year. The American Cancer Society's estimates for breast cancer in the United States for 2023 are: About 297,790 new cases of invasive breast cancer will be diagnosed in women.

At what age are mammograms no longer necessary? ›

For women with no history of cancer, U.S. screening guidelines recommend that all women start receiving mammograms when they turn 40 or 50 and to continue getting one every 1 or 2 years. This routine continues until they turn about 75 years of age or if, for whatever reason, they have limited life expectancy.

Why no mammograms after 70? ›

They found that in women aged 70 to 74, the benefit of screening outweighed the risks, which can include overdiagnosis, overtreatment and the anxiety of a potential breast cancer diagnosis. In women 75 to 84, screening did not substantially reduce the risk of dying from breast cancer.

What percentage of screening mammograms are called back? ›

Mammogram call-back reasons

If you have undergone a mammogram, your imaging office may call you back for a breast ultrasound or other additional testing. Approximately 10 to 12% of women in the United States will need further testing following a mammogram.

What is considered high risk for mammogram? ›

For this average-risk population, the American College of Radiology® and Society of Breast Imaging recommend annual screening mammography starting at age 40. Women with a cumulative lifetime breast risk ≥ 20 percent are considered high-risk.

What is the ACS caution list? ›

The acronym "CAUTION" helps recognize the 7 most common signs of cancer. C for change in bowel or bladder habits, A for a sore that does not heal, U for unusual bleeding or discharge, T for thickening or lump in the breast or elsewhere, I for indigestion, O for obvious change to warts or moles, and N for nagging cough.

What is the ACS recommended age for screening the general population? ›

For people at average risk

The ACS recommends that people at average risk* of colorectal cancer start regular screening at age 45.

What is the ACS cancer mission? ›

The mission of the American Cancer Society is to improve the lives of people with cancer and their families through advocacy, research, and patient support, to ensure everyone has an opportunity to prevent, detect, treat, and survive cancer.

What is Mammo ACS screening bilateral? ›

Bilateral mammography

Bilateral mammograms represent the standard or traditional type of mammography. In these, the mammogram machine x-rays the breast tissue from a top and side view. Since a bilateral screening mammogram only shows the breast tissue from two angles, there's little compensation for overlap.

Is ultrasound better for dense breasts? ›

Extra screening with ultrasound

Any woman who has dense breasts may want to consider supplemental screening, usually with breast ultrasound. Studies show that screening with ultrasound, in addition to mammography, improves detection of breast cancers in women with dense breasts.

Which breast screening is the key for early? ›

A mammogram is an X-ray of the breast. For many women, mammograms are the best way to find breast cancer early, when it is easier to treat and before it is big enough to feel or cause symptoms. Having regular mammograms can lower the risk of dying from breast cancer.

How often should a 75 year old woman have a mammogram? ›

The U.S. Preventive Services Task Force recommends mammography every 2 years for women ages 70-74 [11].

Is it OK to have a mammogram every 2 years? ›

Women age 45 to 54 should get mammograms every year. Women 55 and older should switch to mammograms every 2 years, or can continue yearly screening. Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer.

Can you press too hard during breast exam? ›

Pressure should be just enough to move the skin without disturbing the tissue underneath. Pressing too hard at first could cause a lump to move out of the way. Medium - On the second circle, use medium pressure to feel for changes below the sur- face to mid-level of the breast tissue.

What is the difference between a screening mammogram and a clinical breast exam? ›

The clinical breast exam may find a lump that a woman didn't know was present. The mammogram can detect microcalcifications, tiny deposits of calcium in the breast that may be indicators of breast cancer, or a tumor that cannot be felt through a clinical breast exam.

Can you decline a breast exam? ›

You have the right to refuse any portion of an exam or stop it at any time. You are in charge of your body. Sensitive exams involve the breasts (in female patients), rectum and/or genitals in any patient.

What test is better than a mammogram? ›

A breast ultrasound isn't typically a screening tool for breast cancer. Instead, a physician might order an ultrasound, also called a sonogram, of the breasts if a screening mammogram produces unusual results. A physician might also use a breast ultrasound as a visual guide while performing a biopsy of the breasts.

What are the consequences of breast self-examination? ›

Complications associated with breast self-examination are principally secondary to false-positive findings resulting in increased benign lesion identification, unnecessary imaging, biopsies, and anxiety provoked by a possible cancer diagnosis.

Why do breasts feel so good? ›

Stimulating, caressing or simply holding breasts sends nerve signals to the brain, which trigger the release of the 'cuddle hormone' called oxytocin, a neurochemical secreted by the posterior lobe of the pituitary gland in the brain.

Should doctors do breast exams? ›

Why are breast exams important? Breast exams improve the chances of finding breast cancer early. And the earlier breast cancer is found, the easier it is to treat. Your doctor or nurse can tell whether your breasts look and feel healthy.

What is the gold standard for breast cancer screening? ›

Today, mammography is the gold standard in breast cancer screening in the general population, and, looking ahead, researchers continue to explore ways to improve mammography and screening technologies.

What is the most common marker for breast cancer? ›

Tumor markers are typically proteins that are produced by cancer cells, many of which can be found in the blood. Some examples of such tumor markers in breast cancer are: CA 15-3 and CA 27.29: CA 15-3 and CA 27.29 are two related markers that are made in higher amounts by breast cancer cells.

What is the new test for breast cancer? ›

Positron emission mammography (PEM) is a newer imaging test of the breast that combines some aspects of a PET scan and a mammogram. PEM uses the same type of radioactive tracer injected into the blood as a PET scan. The breast is then lightly compressed while the images are taken, as with a mammogram.

What is the most common age for breast cancer? ›

Most breast cancers are found in women who are 50 years old or older. Some women will get breast cancer even without any other risk factors that they know of.

What are ACS most common cancers? ›

Breast cancer is the most common cancer diagnosed among US women and is the second leading cause of death among women after lung cancer.

Which breast cancer has the lowest survival rate? ›

The poorest prognosis is for metastatic breast cancer (also known as stage IV or advanced breast cancer). This is when the cancer has spread beyond the breast and nearby lymph nodes to other parts of the body.

Does a 75 year old woman need a Pap smear? ›

Women over 65 may hear conflicting medical advice about getting a Pap smear – the screening test for cervical cancer. Current medical guidelines say the test is not necessary after age 65 if your results have been normal for several years.

Why do mammograms stop at age 75? ›

For older women, the USPSTF said there isn't enough evidence of the potential risks and benefits of mammography on which to base a recommendation. Although breast cancer is a leading cause of death in older women, women over 75 haven't been included in studies of mammography.

Are Yearly mammograms really necessary? ›

Mammography Recommendations

The American College of Obstetricians and Gynecologists, American College of Radiology, and Society of Breast Imaging recommend annual mammograms for women at average risk of breast cancer—which is most women—starting at age 40.

At what age does Medicare stop paying for mammograms? ›

There's no cut-off age for Medicare coverage and mammograms. If you're enrolled in Original Medicare, Part B will pay for an annual screening mammogram and diagnostic mammograms if medically necessary.

Should an 87 year old woman get a mammogram? ›

The American Cancer Society advises physicians to continue screening patients as long as they are in “good overall health” and have a life expectancy of 10 year or longer,7 while the American College of Physicians recommends screening to stop at age 74.

Is there an alternative to a mammogram? ›

The MRI, magnetic resonance imaging, may be used for women already diagnosed, to measure or discover other tumors, or it may be used to screen high-risk women. Medical insurance companies often require proof of high risk to approve an MRI screening.

What do dense breasts feel like? ›

Dense breast tissue cannot be felt by a woman, such as during a breast self-exam, or by her doctor during a clinical breast exam. Only a radiologist looking at a mammogram can tell if a woman has dense breasts.

What percentage of mammograms lead to a biopsy? ›

False positive benign biopsy recommendations are estimated to occur in 11% of women receiving annual 3D mammograms but in only 7% of those screened every two years.

How do I stop worrying about my mammogram results? ›

  1. Positive Coping Statements. When your brain is screaming at you to put on the brakes, overcome the negative thought patterns with positive coping statements. ...
  2. Offer Yourself Immediate Rewards. ...
  3. Talk to Friends and Family. ...
  4. Educate Yourself and Set Expectations.

Why are dense breasts a problem? ›

Women with dense breasts have a higher chance of getting breast cancer. The more dense your breasts are, the higher your risk. Scientists don't know for sure why this is true. Breast cancer patients who have dense breasts are not more likely to die from breast cancer than patients with non-dense (fatty) breasts.

Why are clinical breast exams no longer recommended? ›

The American Cancer Society no longer recommends CBEs or BSEs for women with an average risk for breast cancer because research has not associated them with clear benefits in settings where mammography screening is available and awareness is high.

What is a risk factor for dense breast? ›

Women with less body fat are more likely to have more dense breast tissue compared with women who are obese. Take hormone therapy for menopause. Women who take combination hormone therapy to relieve signs and symptoms of menopause are more likely to have dense breasts.

What is the recommendation of the American Cancer Society ACS for initial screening of an African American male for prostate cancer? ›

Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father or brother) diagnosed with prostate cancer at an early age (younger than age 65).

What is the NCCN considerations for breast cancer screening? ›

The NCCN on screening in average-risk women includes the following recommendations : Clinical breast examinations every 1-3 years from age 25-39, then annually from age 40 on. Begin annual screening mammography at age 40 years. Consider tomosynthesis (three-dimensional mammography)

Why can't you get a mammogram before 40? ›

Diagnosing breast cancer in younger women (under 40 years old) is more difficult because their breast tissue is generally denser than the breast tissue in older women, and routine screening is not recommended. Breast cancer in younger women may be more aggressive and less likely to respond to treatment.

What does the American Cancer Society recommend now instead of monthly breast self exams? ›

Instead of breast self-exams, women 40 and older should have yearly mammograms and clinical exams by a physician or nurse.

Which cancer type is a routine screening recommended for average risk patients? ›

Getting screening tests regularly may find breast, cervical, and colorectal (colon) cancers early, when treatment is likely to work best. Lung cancer screening is recommended for some people who are at high risk.

What are the USPSTF recommendations and the American Cancer Society recommendations for lung cancer screening? ›

Annual lung cancer screening is now recommended to begin for patients at age 50 years with a 20-pack-year history instead of age 55 years with a 30-pack-year history.

How important are NCCN guidelines? ›

The NCCN Guidelines® are the recognized standard for clinical direction and policy in cancer care and are the most thorough and frequently updated clinical practice guidelines available in any area of medicine.

What is the most important risk factor for breast cancer screening? ›

The main factors that influence your risk include being a woman and getting older. Most breast cancers are found in women who are 50 years old or older. Some women will get breast cancer even without any other risk factors that they know of.

Should I worry about Birad 3? ›

If the mass is indeterminate or has any suspicious characteristics, a BI-RADS 3 category should not be issued and biopsy should be pursued. In these cases, a wait period is not justified and may delay diagnosis of cancer. Chae et al. demonstrated the radiologist's difficulty using BI-RADS 3 for breast ultrasound.

How often should you get a mammogram if you have dense breasts? ›

If you have dense breast tissue and are at an increased risk of breast cancer due to a genetic mutation or other factors, your care team may recommend alternating MRIs and mammograms every six months.

What is the difference between a bilateral diagnostic mammogram and a screening mammogram? ›

Screening mammograms are performed to detect possible signs of breast cancer before patients experience symptoms of the disease. Diagnostic mammograms are performed to more closely examine the breast tissue, typically following symptoms or after a screening mammogram shows suspicious results.


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