From The Journal of American Medical Association:  

The future of breast cancer screening is likely to entail a more personalized understanding of breast cancer risk, one that incorporates both published risk assessment tools using combinations of known risk factors with newer techniques such as genomics. If women who are at higher risk of aggressive breast cancer could be more accurately identified, for example, it would be possible to more definitively identify those women who are most likely to benefit from earlier and more frequent breast cancer screening and less likely to experience the related harms.

Importance  Breast cancer is a leading cause of premature mortality among US women. Early detection has been shown to be associated with reduced breast cancer morbidity and mortality. 

Objective  To update the American Cancer Society (ACS) 2003 breast cancer screening guideline for women at average risk for breast cancer.

Process  The ACS commissioned a systematic evidence review of the breast cancer screening literature to inform the update and a supplemental analysis of mammography registry data to address questions related to the screening interval. Formulation of recommendations was based on the quality of the evidence and judgment (incorporating values and preferences) about the balance of benefits and harms.

Evidence Synthesis  Screening mammography in women aged 40 to 69 years is associated with a reduction in breast cancer deaths across a range of study designs, and inferential evidence supports breast cancer screening for women 70 years and older who are in good health. Estimates of the cumulative lifetime risk of false-positive examination results are greater if screening begins at younger ages because of the greater number of mammograms, as well as the higher recall rate in younger women. The quality of the evidence for over diagnosis is not sufficient to estimate a lifetime risk with confidence. Analysis examining the screening interval demonstrates more favorable tumor characteristics when pre-menopausal women are screened annually vs biennially. Evidence does not support routine clinical breast examination as a screening method for women at average risk.

Recommendations  The ACS recommends that women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 years (strong recommendation). Women aged 45 to 54 years should be screened annually (qualified recommendation). Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation). Women should have the opportunity to begin annual screening between the ages of 40 and 44 years (qualified recommendation). Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer (qualified recommendation). The ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age (qualified recommendation).

Conclusions and Relevance  These updated ACS guidelines provide evidence-based recommendations for breast cancer screening for women at average risk of breast cancer. These recommendations should be considered by physicians and women in discussions about breast cancer screening.