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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. triennial screening

Issued on: February 2017

Healthcare question

Should annual mammography screening vs. triennial 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 recommendation was conditional due to no net health benefits with annual screening and large costs associated with it.

Considerations for implementation and policy making

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

Monitoring and evaluation

Evaluate existing programmes that already have annual screening in place in order to have data for inter-country comparability. 

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 small amount of evidence available and the very low certainty of it.
  • More reliable data is necessary, particularly in this age group, as the only data comes from a small trial where the mammograms were taken in 1987.
  • More research on the use of other imaging modalities was deemed by the GDG to be useful in 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 use of more consistent modelling studies was also highlighted.
  • 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 that 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

yes