1. ACP issues guidance statement for breast cancer screening of average-risk women with no symptoms
Great majority of average-risk women with no symptoms will benefit from mammography every other year beginning at age 50
In a new evidence-based guidance statement published in Annals of Internal Medicine, the American College of Physicians (ACP) says that average-risk women between the ages of 50 and 74 should undergo breast cancer screening with mammography every other year. ACP’s guidance statement does not apply to patients with prior abnormal screening results or to higher risk populations, such as women with a personal history of breast cancer or a genetic mutation known to increase risk.
In average-risk women between the ages of aged 40 and 49 years, physicians should discuss whether to screen for breast cancer with mammography before age 50. Discussion should include the potential benefits and harms and a woman’s preferences. The potential harms outweigh the benefits in most women aged 40 to 49 years.
Evidence shows that annual mammography results in more harm than mammography every other year, and little difference exists in breast cancer mortality for screening every year versus screening every other year but will substantially reduce screening harms. Compared to women screened every other year, more women screened annually receive a recommendation for a biopsy after a false-positive result biennially (7.0 percent vs. 4.8 percent).
Harms of breast cancer screening include overdiagnosis, overtreatment, false positive results (from a test showing an abnormality even though the woman does not have breast cancer), radiation exposure and radiation associated breast cancers and breast cancer deaths, as well as worry and distress from tests and procedures including breast biopsies. About 20 percent of women diagnosed with breast cancer over a 10-year period will be overdiagnosed and likely overtreated. Overdiagnosis means a woman is diagnosed with a breast cancer that would not have made her sick or led to her death if not diagnosed or treated (overtreatment). Therefore, finding this cancer is not of clinical benefit to the woman.
In an accompanying editorial, Joann G. Elmore, MD, MPH, and Christoph I. Lee, MD, MS, write: “The results of [ACP’s] assessment are 4 guidance statements that provide clarity and simplicity amidst the chaos of diverging guidelines. These ACP guidance statements represent convergence across differing recommendations while highlighting important points for physicians to consider in shared decision-making conversations with their patients about routine breast cancer screening.
Media contact: please contact Steve Majewski at SMajewski@acponline.org or 215-351-2514.