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Cancer Screening, Diagnosis and Care

European guidelines on breast cancer screening and diagnosis


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3. Screening ages and frequencies

Women aged 45-49: annual vs. biennial screening

Issued on: February 2017

Healthcare question

Should annual mammography screening vs. biennial mammography screening be used for early detection of breast cancer in women aged 45 to 49?

Recommendation

For asymptomatic women aged 45 to 49 with an average risk of breast cancer, the ECIBC's Guidelines Development Group (GDG) suggests not implementing annual mammography screening in the context of an organised population-based screening programme

Recommendation strength

Conditional recommendation
Very low certainty of the evidence

Justification

The conditional recommendation against annual screening was the result of the health effects that probably favour biennial screening, although the certainty of the evidence was very low.

Subgroup considerations

The GDG noted that women with a strong family history may be considered for more frequent screening within screening programmes as in the United Kingdom. Other countries do more intensive surveillance for high-risk women. 

Considerations for implementation and policy making

The GDG noted that there is variability in the acceptability between countries and that the current practice will impact the ease of implementation and the acceptability of this intervention to key stakeholders.

The GDG agreed that the possibility of using other imaging techniques in this subgroup of women may be relevant to consider.

Monitoring and evaluation

Careful monitoring of interval cancer rates in this age group is warranted.

Research priorities

  • The GDG agreed that more research on the effectiveness of the different screening intervals through comparative studies would be helpful due to the very low certainty of the evidence.
  • Less information is available for certain outcomes in this age group (e.g. interval cancer).
  • The GDG noted that cost-effectiveness research would be helpful to further assess this screening interval in women aged 45 to 49.
  • The GDG noted that there is a lack of research on other imaging modalities between screening intervals with mammography for women of this age group.
  • There was discussion in the GDG whether women with dense breasts in this age group should be screened at different intervals.
  • The GDG felt that increased cost effectiveness data, having more contextualised costs and cost-effectiveness analysis and from other settings would be helpful for future recommendations; this included checking the consistency of cost-effectiveness models with new research from trials on breast cancer screening and natural history of breast cancer disease. Also many countries have cost analysis but they are not publicly available, and this should be shared with the scientific community. This priority may apply to all other screening interval recommendations.

Supporting material

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