Weighing the Benefits and Risks of Screening Mammography

Mammography is a screening test for breast cancer. It’s used to find breast cancer early, before it causes any warning signs or symptoms, when the chances of long-term survival are highest.

Regular screening mammography (along with follow-up tests and treatment, if diagnosed) reduces the chance of dying from breast cancer. However, the benefits and risks are not the same for all women.

There are questions related to:

• How much benefit mammography offers
• The overdiagnosis and overtreatment of ductal carcinoma in situ (DCIS) and small, slow-growing invasive breast cancers

This has led to different recommendations for when to start getting screening mammograms and how often to have them.

Benefits of mammography

The benefits of screening mammography vary by age. Women ages 50-69 get the most overall benefit for a number of reasons [34].

For example, breast cancer in women 50 and older is much more common than breast cancer in women younger than 50 [53].

 

Benefits of screening mammography by age group
Age group	A meta-analysis of randomized controlled trials found:
39-49	Women who got mammograms may have had a lower risk of dying from breast cancer compared to women who didn’t get mammograms. However, the benefit was small (0%-5% lower risk) and was less than for older women.
50-59	Women who got mammograms had a 14% lower risk of dying from breast cancer compared to women who didn’t get mammograms.
60-69	Women who got mammograms had a 33% lower risk of dying from breast cancer compared to women who didn’t get mammograms.
Adapted from U.S. Preventive Services Task Force [34].

Getting regular screening mammograms lowers the risk of dying from breast cancer, but it doesn’t completely remove the risk.

The benefits of mammography are real, but it’s not a perfect test. Some women who get regular screening mammograms will be diagnosed with breast cancer and unfortunately, some women will die from the disease.

Overdiagnosis and overtreatment

Overdiagnosis and over-treatment are the main risks of screening mammography.

Overdiagnosis

Overdiagnosis occurs when a screening mammogram finds ductal carcinoma in situ (DCIS) or small, invasive breast cancers that would have never caused symptoms or problems if left untreated.

These breast cancers may never grow, and some may even shrink on their own. Or a person may die from another cause before breast cancer becomes a problem.

Studies suggest 5%-50% of DCIS and small, invasive breast cancers found with screening mammography may be over-diagnosed [23,36,54-59]. A meta-analysis of 3 randomized controlled trials found over-diagnosis from mammography was 19% [60].

Even without treatment, these over-diagnosed breast cancers would never cause problems in a person’s lifetime.

Overtreatment

Overtreatment occurs when a cancer that wouldn’t have caused symptoms or problems is found (overdiagnosis) and treated. This means even without treatment the breast cancer would never have caused a problem. So, a person would be exposed to the risks (including side effects) of treatment but get no benefit.

Overtreatment is a concern for those with DCIS and some very early invasive cancers.

Although DCIS is non-invasive, without treatment, the abnormal cells can progress to invasive breast cancer over time. Left untreated, it’s estimated 10%-50% of DCIS cases may progress to invasive breast cancer [59,61-62,64]. In the same way, small, invasive breast cancers may grow over time.

Health care providers cannot predict which cases of DCIS will progress to invasive breast cancer and which cases will not. There’s also no way to tell which small, invasive breast cancers will progress if left untreated. So, all these breast cancers are treated.

Since not all cases of DCIS and small, invasive breast cancer will progress, some women may be over-treated.

Under study

Researchers are studying ways to identify which cases of DCIS and small, invasive breast cancer are most likely to progress. This would help direct treatment to cases at higher risk of progressing. It might also allow some people to avoid treatment.

Researchers are also studying whether some cases at a lower risk of progressing can be treated less aggressively than they are treated now.

Learn more about DCIS.

Other risks of mammography

False positives and follow-up tests

Sometimes a screening mammogram shows something abnormal that might be cancer but turns out not to be cancer. This is called a false positive result.

If your mammogram shows something abnormal, you’ll need follow-up tests to check whether or not the finding is breast cancer.

These tests may include a follow-up mammogram (diagnostic mammogram), breast ultrasound or breast MRI. Sometimes, a biopsy is needed. A biopsy removes a small amount of tissue in the breast to check for cancer.

If you have an abnormal finding on a screening mammogram, it’s normal to be concerned. However, most abnormal findings are not breast cancer [22].

Learn more about follow-up after an abnormal mammogram.

What does this mean for you?

Despite the ongoing debate about the balance of benefits and risks, for most women, mammography is the most effective breast cancer screening test used today.

While any health decision is a personal one that involves weighing benefits and risks, most health organizations recommend women get screening mammograms on a regular basis.

Figure 3.1 shows breast cancer screening recommendations for women at average risk.

Susan G. Komen® believes all women should have access to regular screening mammograms when they and their health care providers decide it’s best based on their risk of breast cancer.

Learn about breast cancer screening recommendations for women at higher risk.

	For a summary of research studies on mammography in women ages 40-49, visit the Breast Cancer Research Studies section.
	For a summary of research studies on mammography in women ages 50-69, visit the Breast Cancer Research Studies section.

 

My Family Health History Tool

My Family Health History tool is a web-based tool that makes it easy for you to record and organize your family health history. It can help you gather information that’s useful as you talk with your family members, doctor or genetic counselor.

 

Radiation exposure during a mammogram

You’re exposed to a small amount of radiation during a mammogram.

While the radiation exposure during a mammogram can increase the risk of breast cancer over time, this increase in risk is very small [12-15].

Learn more about radiation exposure during a mammogram.

Updated 04/03/23