Screening for breast cancer with mammography has been shown in multiple randomized control trials to decrease breast cancer mortality. Despite this, there are ongoing controversies regarding the benefits and risks of mammographic screening. Different professional groups have published conflicting guidelines regarding when to start screening, how often to screen, and when to stop screening which have added to the confusion. In this article we describe the evidence supporting and challenging the efficacy of mammography and review our real world approach to breast cancer screening.