Paulo Bandeira Pinho, MD, FAAP

Text Box: Breast cancer screening

Information from


CBE—Clinical Breast Exam

BSE—Breast Self Exam


What Has Changed and Why


Former guidelines (1997)

Updated guidelines and information (May 2003)


Women at average risk


Annually starting at age 40

No change from 1997 recommendation. There is a tremendous amount of additional, credible evidence of the benefit of mammography since 1997, especially regarding women in their 40s.

Women can feel confident about the benefits associated with regular screening mammography. However, mammography also has limitations: it will miss some cancers, and it sometimes leads to follow up of findings that are not cancer, including biopsies.


Every three years for women 20-39; annually for women 40 and older

CBE should be part of a woman’s periodic health examination, about every three years for women in their 20s and 30s and annually for women 40 and older.

CBE is a complement to regular mammography screening and an opportunity for women and their health care providers to discuss changes in their breasts, risk factors, and early detection testing.


Monthly starting at age 20

Women should report any breast change promptly to their healthcare provider.Beginning in their 20s, women should be told about the benefits and limitations of BSE. It is acceptable for women to choose not to do BSE or to do it occasionally.

Research has shown that BSE plays a small role in detecting breast cancer compared with self awareness. However, doing BSE is one way for women to know how their breasts normally feel and to notice any changes.

Older women and women with serious health problems

Additional research is needed.

Continue annual mammography, regardless of age, as long as a woman does not have serious, chronic health problems. For women with serious health problems or short life expectancy, evaluate ongoing early detection testing.

There is a need to balance the potential benefits of ongoing screening mammography in women with limited longevity against the limitations. The survival benefit of a current mammogram may not be seen for several years.

Women  known to be at increased risk

Women known to be at increased risk

Women with a family history of breast cancer should discuss guidelines with their doctors.

Women known to be at increased risk may benefit from earlier initiation of early detection testing and/or the addition of breast ultrasound or MRI.

The evidence available is only sufficient to offer general guidance. This guidance will help women and their doctors make more informed decisions about screening