Breast Cancer Screening

Who developed these recommendations?

The American College of Physicians (ACP) developed these recommendations. The ACP is a professional organization for internal medicine doctors, who specialize in health care for adults.

What is the problem and what is known about it so far?

Breast cancer is the most common cancer in women. It is the fourth leading cause of cancer death in the United States. Breast cancer screening can find signs of cancer before symptoms begin, when it is more likely to be curable. The screening test is a mammogram, a special kind of x-ray most commonly used to find breast cancer. Different organizations have different recommendations about ages to start and stop breast cancer screening and how often to do screening tests.

How did the ACP develop these recommendations?

The ACP Clinical Guidelines Committee reviewed selected guidelines on breast cancer screening from around the world. They evaluated the quality of these guidelines to help doctors and patients make decisions about breast cancer screening in women who are at average risk (which is most women). The guidance does not address women at high risk for developing breast cancer.

What are the benefits and harms of breast cancer screening in average-risk women?

Breast cancer screening can lead to early detection and treatment, which may reduce death from breast cancer, generally in women aged 50 to 69 years. However, screening tests may also cause harms. These harms can include overdiagnosis and overtreatment, which occur when breast cancer is detected in women who would never have been bothered by or died from cancer. Such women may experience harms, including emotional and physical harms (for example, from chemotherapy), without benefit. Other harms include “false-positive” results (when an abnormality is found that is not cancer) and the pain and worry from follow-up tests, such as unnecessary biopsies. Radiation exposure from mammograms also increases with the number of mammograms a woman has over her lifetime, which could increase her risk for radiation-associated breast cancer.

What does “average-risk” mean?

For the purpose of these recommendations, an “average-risk” woman is one who does not have any of the following:

  • personal history of breast cancer;
  • previously diagnosed high-risk breast lesion;
  • any genetic mutation known to increase the risk for breast cancer; or
  • history of exposure to radiation to the chest in childhood.

What does the ACP suggest that patients and doctors do?

Average-risk women between the ages of 40 and 49 years should discuss the benefits and risks of breast cancer screening with their doctors. These patients should consider the facts along with their own personal values and preferences about screening to make an individualized decision. The potential harms of screening outweigh the benefits for most women in this age bracket.
Doctors should offer breast cancer screening with a mammogram every 2 years to average-risk women between the ages of 50 and 74 years.
Doctors should stop screening for breast cancer in average-risk women aged 75 years or older or in women with a life expectancy of 10 years or less.
Doctors should not use clinical breast examinations to screen for breast cancer.

Questions you may want to ask your doctor

What is my personal risk for breast cancer?

When should I start screening for breast cancer?

What are the benefits of screening, and do they vary by age?

What harms from breast cancer screening should I consider?

If I undergo screening, how often should I be screened?

When should I stop breast cancer screening?

This article was published at Annals.org on 9 April 2019.

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