The National Comprehensive Cancer Network (NCCN) recommends annual mammograms for all average-risk women over 40 in its newly published Breast Cancer Screening and Diagnosis, the latest in a series of free guidelines for cancer patients. What’s more, women should start a assessing breast cancer risk much earlier than previously advised: when they’re 25.

The guidelines aim to help people understand the importance of breast cancer screening and to answer questions regarding screening basics, risk assessment for screening, tests during pregnancy and breast feeding, questions to ask health care professionals and more.

“There are many, often conflicting, recommendations surrounding breast cancer screening, which causes a lot of confusion and apprehension,” Therese Bevers, MD, professor of clinical cancer prevention at the University of Texas MD Anderson Cancer Center and chair of the NCCN Guidelines Panel for Breast Cancer Screening and Diagnosis, said in an NCCN press release. “These are the latest, evidence-based guidelines from experts in the field of breast cancer screening and diagnosis from more than two dozen leading cancer centers in the United States.”

These guidelines encourage regular screening because the earlier cancer is detected, the more successful treatment is likely to be. One chapter in the 54-page report explains the difference between screening and diagnostic tests:

  • A screening is done on a regular basis when there are no symptoms. A screening mammogram is the only imaging test that has been found to reduce breast cancer–related deaths.

  • A diagnostic test is done when there are signs or symptoms such as a lump felt in the breast or changes in the skin of the breast or nipple. Diagnostic mammograms include extra compression in certain areas of the breast to evaluate whether additional breast imaging is needed right away.

  • Both types of mammograms use low-dose X-rays to examine the breast using either standard two-dimensional (2D) digital mammography or 3D mammograms known as tomosynthesis, which may help to see small abnormal areas in the breast more easily.

The report includes basics on the biology of the breast as well as an introduction to the health care providers patients often encounter during regular health checkups and breast cancer screenings, including breast specialists, gynecologists, breast diagnostic radiologists, obstetricians, lactation consultants, mammogram, MRI and ultrasound technologists and pathologists.

“Everyone with breasts carries some risk of breast cancer, so the key is to know your risk,” Bevers said. “Most women with average risk should get screened every year, beginning at age 40, but if there are additional risk factors present, a provider might recommend an earlier start.”

The National Comprehensive Cancer Network’s 2022 guidelines for breast cancer patients

Cover of the guidelinesCourtesy of

The report also describes risk assessment for screening. While everyone has some risk for developing breast cancer, some are at increased risk. Risk assessment is based on age, reproductive history and the following factors:

  • Family history or genetic testing that suggests a genetic predisposition to breast, ovarian or pancreatic cancer

  • If you’ve had radiation therapy to the chest between 10 and 30 years of age

  • If you have the gene BRCA1 or BRCA2 that predisposes you to breast cancer

“These guidelines will help so many people,” Sue Friedman, DVM, the executive director of Facing Our Risk of Cancer Empowered, said in the NCCN press release. “There is general confusion about breast cancer screening guidelines and what screening people should follow based on their risk. NCCN patient guidelines are an easy way for people to access up-to-date expert recommendations in plain language.”

The NCCN is a nonprofit alliance of leading cancer centers. In addition to publishing cancer guidelines, the group advocates for cancer issues and helps educate patients and the general population.