Guidelines for detection of breast cancer: an update on investigative methods. A report of the ad hoc committee on mammography of The Canadian Association of Radiologists.

The high incidence of breast cancer and its mortality make it imperative that women over 25 years of age have a clinical examination of their breasts at least every three years up to age 40 and annually thereafter. Before the age of 25, mammography is seldom indicated and then it should usually be limited to a spot film of a potential lesion. After 25, mammography is indicated for any woman with breast symptoms, women with metastases from cancer of an unknown primary site, and before any breast surgery. Women with a strong family history and those with large breasts should also have a mammogram between the ages of 25 and 35. Between the ages of 35 and 39 we recommend a baseline mammogram for asymptomatic women. After 39 and up to age 50, women should consult their physicians yearly to determine if, and how often, mammography should be performed. Finally, after age 50, annual mammography is suggested. In each of the above contexts, the radiologic examination should be coupled with clinical palpation of the breasts. A trained and experienced mammographer should recommend biopsy when mammograms show a typical spiculated mass; an ill-defined or even well defined mass that cannot be said to be benign; a suspicious distortion of local architecture; or a cluster of suspicious microcalcifications. Any cyst the nature of which is uncertain after puncture, or abnormal ducts on a galactogram also should make a biopsy mandatory. On the other hand, a normal mammogram should not prevent biopsy of a lesion of the nipple or of a lump detected clinically.(ABSTRACT TRUNCATED AT 250 WORDS)