Table 3.

The screening recommendations in average-risk women in eligible guidelines.

Guidelines	Age range for screening	Age to end screening	Screening methods	Screening intervals	Recommendations for other screening methods
WHO, 2014 [16]	40–49 years; 70-74 years	NR	MAM ●Conditional recommendation in well-resourced settings; ●Strong recommendation against screening in limited resource settings with weak or relatively strong health systems	NR	NR
	50–69 years		MAM ●Strong recommendation in well-resourced settings; ●Conditional recommendation in limited-resource settings with relatively strong health systems	Biennial ●Conditional recommendation in well-resourced settings; ●Conditional recommendation in limited resource settings	CBE seems to be a promising approach in limited resource settings with weak health systems
ACP, 2019 [17]	40–49 years	≥ 75 years or in women with a life expectancy of 10 years or less	NR ●Discuss; offer if chosen by SDM	NR	Not recommend CBE
	50–74 years		MAM	Biennial
NCCN, 2019 [18]	25–39 years	■Not established an upper age for screening; ■Screening decisions should be based on severe comorbid conditions limiting life expectancy and no further intervention would occur based on the screening findings	Clinical encounter ●Includes breast cancer risk assessment, risk reduction counseling, and CBE	Every 1–3 years	■Ultrasonography is used for diagnostic follow-up of an abnormality seen on screening MAM and palpable clinical concerns, not recommended as a universal supplemental screening test in average-risk women; ■MRI is recommended in high-risk women; ■Thermography and ductal lavage are not recommended
	≥ 40 years		Clinical encounter ●Includes breast cancer risk assessment, risk reduction counseling, and CBE; ●Category 1 recommendation	Annual
			MAM ●Category 1 recommendation; ●Consider tomosynthesis	Annual
ACR, 2017 [19]	≥ 40 years	NR	MAM or DBT	Annual	For women with dense breasts, US may be considered, but the increased cancer detection and the increased risk of a false-positive examination should be weighed
ACR (Average-risk), 2017 [21]	≥ 40 years	The age to stop screening should be based on each woman's health status rather than an age-based determination	MAM	Annual	No sufficient data to support the use of breast MRI and MBI as a screening tool for average-risk women
ACR and SBI, 2010 [22]	≥ 40 years	■When life expectancy is 5 to 7 years on the basis of age or comorbid conditions; ■When abnormal results of screening would not be acted on because of age or comorbid conditions	MAM	Annual	NR
USPSTF, 2016 [7]	40–49 years	75 years ●I statement (insufficient evidence)	MAM ●Discuss; offer if chosen by SDM; ●C recommendation	Biennial ●C recommendation	■No sufficient data to support DBT as a primary screening method [I statement]; ■No sufficient data to support adjunctive screening with US, MRI, and DBT for women with dense breasts on an otherwise negative screening mammogram [I statement]
	50–74 years		MAM ●B recommendation	Biennial ●B recommendation
ACS, 2015 [23]	40–44 years	Screening should continue as long as a woman is in good health and is expected to live at least 10 more years	MAM ●Discuss; offer if chosen by SDM	Annual ●Qualified recommendation	Not recommend CBE
	45–54 years		MAM ●Strong recommendation	Annual ●Qualified recommendation
	≥ 55 years		MAM ●Strong recommendation	Annual or biennial ●Qualified recommendation
ACOG, 2019 [24]	25–39 years	■Continue until age 75 years; ■＞ 75 years, the decision to discontinue should be based on a shared decision making process that includes a discussion of the women's health status and longevity	CBE ●Level C	Every 1–3 years ●Level C	■Not recommend BSE [level B]; ■CBE may be offered to asymptomatic, average-risk women in the context of an informed, SDM approach. (every 1–3 years for women aged 25–39 years and annually for women age 40 years and older)
	≥ 40 years		MAM ●Start no later than age 50; ●Level A	Annual or biennial ●Level A Biennial (after age 55) ●Level A
			CBE ●Level C	Annual ●Level C
ECIBC, 2020 [25]	45–49 years	NR	MAM ●Conditional recommendation	■ Either biennial or triennial mammography over annual screening ● Conditional recommendation	■Screen digital mammography alone over screen with DBT alone or with DBT in addition to digital mammography [conditional recommendation]; ■For asymptomatic women with high mammographic breast density and negative mammography results, screening with ABUS or HHUS or MRI over mammography alone is not recommended
	50–69 years		MAM ■Strong recommendation	■ Against annual mammography screening ● Strong recommendation ■ Biennial mammography screening over triennial mammography screening ● Conditional recommendation
	70–74 years		MAM ■Conditional recommendation	■ Against annual mammography screening ● Strong recommendation ■ Triennial mammography screening over biennial mammography screening ● Conditional recommendation
ESMO, 2019 [8]	40–49 years; 70–74years	NR	MAM [B]	NR	NR
	50–69 years		MAM [A]	Annual or biennial [A]
CTFPHC, 2018 [27]	50–74 years	NR	MAM ●Conditional recommendation	Every 2–3 years ●Conditional recommendation	■Not using MRI, tomosynthesis or US to screen for breast cancer in women who are not at increased risk [strong recommendation]; ■Not performing CBE to screen for breast cancer [conditional recommendation]; ■Not advising women to practice BSE to screen for breast cancer [conditional recommendation]
AWMF, DKG, and DKH, 2020 [28]	50–69 years	≥ 70 years: taking into consideration their individual risk profile and health status, as well as a life expectancy of more than 10 years	MAM	Biennial	Insufficient evidence about other imaging examination (tomosynthesis, US, MRI, or other techniques) contributes to a reduction in breast cancer mortality, neither as a supplemental examination nor a substitute for MAM
Cancer Australia, 2015 [29]	40–49 years	≥ 75 years: be eligible to receive free MAM, but do not receive an invitation to attend	MAM (discuss, by SDM)	NR	No evidence to recommend for or against CBE
	50–74 years		MAM	Biennial
MOH of Singapore, 2010 [30]	40–49 years	≥70 years: be individualized by considering the potential benefits and risks of mammography in the context of current health status and estimated life expectancy	MAM ●discuss, by SDM; ●Grade C	Annual ●Grade C	US and CBE are not routinely required
	50–69 years		MAM ●Grade A	Biennial ●Grade A
MOH of Malaysia, 2019 [31]	50–74 years	NR	MAM	Biennial	NR
NCC Japan, 2016 [9]	40–64 years	NR	MAM with CBE	NR	CBE and US are not recommended for population-based screening
	40–74 years		MAM without CBE
NCC China, 2021 [32]	≥ 45 years	NR	■ MAM ● Strong recommendation ■ US ● Strong recommendation	Annual or biennial ●Strong recommendation	■Women with dense breast: combine MAM with US [strong recommendation]; ■Not recommend MRI [strong recommendation]
MOH of Brazil, 2018 [34]	50–69 years	■75 years [strong recommendation]; ■70–74 years [weak recommendation]	MAM ●Weak recommendation	Biennial ●Strong recommendation	■Recommend against BSE [weak recommendation]; ■Recommend against MRI, US, thermography, and tomosynthesis, either alone or with MAM [strong recommendation]
CBR, SBM, and FEBRASGO, 2017 [35]	40–74 years	≥ 75 years ●Recommended for women with an expected survival >7 years, depending on comorbidities; ●Category D recommendation	MAM (preferably digital MAM) ●Category A recommendation	Annual ●Category A recommendation	■US: be considered as an adjunct to mammography in women with dense breasts. [category B recommendation]; ■MRI: no data to support breast cancer screening with magnetic resonance imaging for women within the population at average risk; ■Tomosynthesis: be considered in association with digital mammography. [category B recommendation]

Abbreviations: ABUS: Automated Breast Ultrasonography; ACOG: American College of Obstetricians and Gynecologists; ACP: American College of Physicians; ACR: American College of Radiology; ACS: American Cancer Society; AWMF: German Association of Scientific Medical Societies; BSE: Breast Self-Examination; CBE: Clinical Breast Examination; CBR: The Brazilian College of Radiology and Diagnostic Imaging; CTFPHC: Canadian Task Force on Preventive Health Care; DKG: German Cancer Society; DKH: German Cancer Aid; DBT: Digital Breast Tomosynthesis; ECIBC: European Commission Initiative on Breast Cancer; ESMO: European Society for Medical Oncology; FEBRASGO: Brazilian Federation of Gynecological and Obstetrical Associations; HHUS: Hand-Held Ultrasound; MAM: Mammography; MBI: Molecular Breast Imaging; MOH: Ministry of Health; MRI: Magnetic Resonance Imaging; NCC: National Cancer Centre; NCCN: National Comprehensive Cancer Network; NR: No Recommendation; SBM: The Brazilian Society for Breast Disease; SDM: Shared Decision Making; US: Ultrasound; USPSTF: U.S. Preventive Services Task Force; WHO: World Health Organization.