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APPENDIX B 130 SCREENING FOR BREAST CANCER Recommendation: All women over age 40 should receive an annual clinical breast examination. Mammography every one to two years is recommended for all women beginning at age 50 and concluding at approximately age 75 unless pathology has been detected. It may be prudent to begin mammography at an earlier age for women at high risk for breast cancer (see Clinical Intervention). Although the teaching of breast self-examination is not specifically recommended at this time, there is insufficient evidence to recommend any change in current breast self- examination practices. Burden of Suffering In the United States in 1989, an estimated 142,000 new cases of breast cancer will occur in women, and 43,000 women will die of this disease. 1 Breast cancer accounts for 28% of all newly diagnosed cancers in women and 18% of female cancer deaths.1 The age-adjusted mortality rate from breast cancer has been almost unchanged over the past 10 years. Breast cancer is the leading contributor to premature cancer mortality in women. 2 Because women of the "baby boom" generation are now reaching age 40, the number of breast cancer cases and deaths will increase substantially over the next 40 years unless age-specific incidence and mortality rates decline. Important risk factors for breast cancer include sex, geographic location, and age. Breast cancer is much more common in women than men,nd the highest rates of breast cancer exist in North America and northern Europe. In American women, the annual incidence of breast cancer increases rapidly with age, from approximately 20 per 100,000 at
