ACP recommends biennial breast cancer screening starting at age 50 for most women
The ACP released four guidance statements for breast cancer screening in women with an average risk and no symptoms, which highlighted that a majority of women in this population aged between 50 and 74 years would benefit the most from mammography every other year.
“Breast cancer is the most common cancer type in women and the fourth-leading cause of cancer death in the United States,” Amir Qaseem, MD, PhD, MHA, for the Clinical Guidelines Committee of the ACP, and colleagues wrote.
“Recommended strategies vary for breast cancer screening in average-risk women,” they added.
The guidance statements, published in Annals of Internal Medicine, were based on a review of existing guidelines and evidence on breast cancer screening in average-risk asymptomatic women published between Jan. 1, 2013, and Nov. 15, 2017, and offer comprehensive recommendations to clinicians.
Authors reviewed guidelines from the American College of Radiology, American Cancer Society, USPSTF, National Comprehensive Cancer Network, WHO and American College of Obstetricians and Gynecologists.
After their review, they made four guidance statements:
- Clinicians should discuss whether to screen for breast cancer with mammography in women aged 40 to 49 years with an average risk for breast cancer. These discussions should consider the potential benefits and harms and the patient’s preferences. In most women in this age range, the potential harms outweigh the benefits.
- Clinicians should screen average-risk women aged 50 to 74 years for breast cancer with mammography every other year.
- Clinicians should discontinue breast cancer screening in women aged 75 years or older with an average risk and a life expectancy of 10 years or less.
- Clinical breast examination should not be used to screen for breast cancer in average-risk women of all ages.
The guidance statements do not pertain to women with a higher risk for breast cancer, such as those who have had abnormal screening results in the past, a personal history of breast cancer or a mutation in the BRCA1 or BRCA2 gene, according to a press release issued by ACP.
Clinicians should be aware that breast cancer is overdiagnosed and overtreated in about one in five women who have been diagnosed with breast cancer, according to the release. Other common harms of breast cancer screening include false positive results, radiation exposure, radiation-associated breast cancers and breast cancer deaths and distress from tests and procedures, according to the release.
In a related editorial, Joann G. Elmore, MD, MPH, from the David Geffen School of Medicine at the University of California, Los Angeles, and Christoph I. Lee, MD, MS, from the University of Washington School of Medicine, wrote that ACP’s guidance statements “provide clarity and simplicity amidst the chaos of diverging guidelines.”
The statements unite different recommendations from other organizations by highlighting the important points for clinicians to consider for routine breast cancer screening, they wrote.
“It is our hope that future guidance statements will move beyond emphasizing variation across guidelines and instead provide more advice on how to implement high-value screening and deimplement low-value screening,” Elmore and Lee concluded.
“Until we have automated, technologic solutions that assess risk status and validated practices for having difficult conversations about informed decision making, physicians are left to use their best judgment based on available research and expert recommendations,” they added. “The ACP guidance statements shed light on these points but do not clearly illuminate the full path ahead for every woman.” – by Alaina Tedesco
Disclosures: Elmore reports being the editor-in-chief at UpToDate and the director of the National Clinician Scholars Program at University of California, Los Angeles. Lee reports receiving grants from GE Healthcare, payments from the American College of Radiology and textbook royalties from McGraw-Hill, Inc., Oxford University Press and Wolters Kluwer. Qaseem and colleagues report no relevant financial disclosures.