ACP guidance statement for screening of breast cancer in average-risk women

The American College of Physicians (ACP) has released a guidance statement for the screening of breast cancer in average-risk women.

Breast cancer is the most common cancer type in women and is the leading cause of cancer death across the world. The goal of screening is to reduce morbidity and mortality, both specific to breast cancer and overall, with acceptable tradeoffs. The most commonly used screening test is mammography. Recommended strategies vary for breast cancer screening in average-risk women. Ages to start and discontinue mammography, screening intervals, the role of imaging methods other than mammography, and the role of clinical breast examination (CBE) have been points of disagreement among guideline developers.

The goal of this ACP guidance statement is to critically review selected guidelines from around the world and their included evidence to assist clinicians in making decisions about breast cancer screening in asymptomatic women with average risk for breast cancer.

• In average-risk women aged 40 to 49 years, clinicians should discuss whether to screen for breast cancer with mammography before age 50 years. The 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.


• In average-risk women aged 50 to 74 years, clinicians should offer screening for breast cancer with biennial mammography.


• In average-risk women aged 75 years or older or in women with a life expectancy of 10 years or less, clinicians should discontinue screening for breast cancer.


• In average-risk women of all ages, clinicians should not use clinical breast examination to screen for breast cancer.

"For average-risk women, annual screening mammography or DBT (with accompanying planar or synthesized [2-dimensional] images) is recommended beginning at age 40. For women with dense breasts, [ultrasonography] may also be considered, but the balance between increased cancer detection and the increased risk of a false-positive examination should be considered in the decision," write the authors.