Breast Cancer Screening for Women at Average Risk – 2015 Guidelines

American Cancer Society, in a Shift, Recommends Fewer Mammograms

Despite the substantial interest and investment in research on breast cancer screening, there is uncertainty about the magnitude of mammography’s benefits and harms and how to select patients and screening strategies to optimize the balance between benefits and harms.
Despite the substantial interest and investment in research on breast cancer screening, there is uncertainty about the magnitude of mammography’s benefits and harms and how to select patients and screening strategies to optimize the balance between benefits and harms. The American Cancer Society, which has for years taken the most aggressive approach to screening, issued new guidelines, recommending that women should begin mammograms later and have them less frequently than it had long advocated.
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2015 Study Abstract

Importance
Breast cancer is a leading cause of premature mortality among US women. Early detection has been shown to be associated with reduced breast cancer morbidity and mortality.

Objective
To update the American Cancer Society (ACS) 2003 breast cancer screening guideline for women at average risk for breast cancer.

Process
The ACS commissioned a systematic evidence review of the breast cancer screening literature to inform the update and a supplemental analysis of mammography registry data to address questions related to the screening interval. Formulation of recommendations was based on the quality of the evidence and judgment (incorporating values and preferences) about the balance of benefits and harms.

Evidence Synthesis
Screening mammography in women aged 40 to 69 years is associated with a reduction in breast cancer deaths across a range of study designs, and inferential evidence supports breast cancer screening for women 70 years and older who are in good health. Estimates of the cumulative lifetime risk of false-positive examination results are greater if screening begins at younger ages because of the greater number of mammograms, as well as the higher recall rate in younger women. The quality of the evidence for overdiagnosis is not sufficient to estimate a lifetime risk with confidence. Analysis examining the screening interval demonstrates more favorable tumor characteristics when premenopausal women are screened annually vs biennially. Evidence does not support routine clinical breast examination as a screening method for women at average risk.

Recommendations
The ACS recommends that women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 years (strong recommendation). Women aged 45 to 54 years should be screened annually (qualified recommendation). Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation). Women should have the opportunity to begin annual screening between the ages of 40 and 44 years (qualified recommendation). Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer (qualified recommendation). The ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age (qualified recommendation).

Conclusions and Relevance
These updated ACS guidelines provide evidence-based recommendations for breast cancer screening for women at average risk of breast cancer. These recommendations should be considered by physicians and women in discussions about breast cancer screening.

Sources and more information – October 2015
  • Breast Cancer Screening for Women at Average Risk 2015 Guideline Update From the American Cancer Society, JAMA. articleid=2463262 2015;314(15):1599-1614. doi:10.1001/jama.2015.12783, October 20, 2015.
  • New Guidelines for Breast Cancer Screening in US Women, JAMA. articleid=2463237 2015;314(15):1569-1571. doi:10.1001/jama.2015.13086, October 20, 2015.
  • Benefits and Harms of Breast Cancer Screening A Systematic Review, JAMA. articleid=2463261 2015;314(15):1615-1634. doi:10.1001/jama.2015.13183, October 20, 2015.
  • Measuring the Effectiveness of Mammography, JAMA Oncol. articleid=2456189#ced150019r1 Published online October 20, 2015. doi:10.1001/jamaoncol.2015.3286.
  • Breast Tumor Prognostic Characteristics and Biennial vs Annual Mammography, Age, and Menopausal Status, JAMA Oncol. articleid=2456190 Published online October 20, 2015. doi:10.1001/jamaoncol.2015.3084, October 20, 2015.
  • American Cancer Society, in a Shift, Recommends Fewer Mammograms, nytimes, OCTOBER 20, 2015.

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