Women with an average risk of breast cancer may begin annual mammography screening at age 45 and get screened less often, according to new guidelines issued by the American Cancer Society (ACS) and published in JAMA.
In an update to its 2003 breast cancer screening guidelines, the ACS commissioned an interdisciplinary guideline development group (GDG) made up of clinicians, biostatisticians, epidemiologists, economists, and patient representatives to perform a systematic evidence review of current breast cancer screening literature and a meta-analysis of observational studies and randomized controlled trials. Twenty-six relevant outside organizations and 22 expert advisors were invited to participate in an external guideline review prior to final publication.
“The 2015 updated recommendations from the ACS are intended to balance the goal of reducing the burden of breast cancer against the understanding that breast cancer screening is a preventative health intervention applied to the entire eligible population of women, most of who will not develop breast cancer in their lifetime,” wrote lead investigator Kevin C. Oeffinger, MD, Director of the Adult Long-Term Follow-Up Program at Memorial Sloan Kettering Cancer Center in New York City, and colleagues.
Based on a consensus reached by the GDG, the new recommendations are as follows: 1) Women with an average risk of breast cancer should undergo regular mammography screening beginning at age 45 and continuing yearly until age 54. Women between the ages of 40 and 44 should have the opportunity to begin annual screening, and women age 55 and older should transition to biannual screening; 2) women should continue to undergo mammography screening based on these recommendations so long as their overall health is good and they have a life expectancy of 10 years or longer; and 3) the ACS no longer recommends clinical breast examinations among average-risk women at any age.
“Despite substantial interest and investment in research on breast cancer screening, there is uncertainty about the magnitude of mammography’s benefits and harms,” said Nancy L. Keating, MD, MPH, Professor of Health Care Policy and Medicine at Harvard Medical School in a corresponding JAMA editorial. “In the face of such uncertainty, thoughtful, evidence-based guidelines can play a powerful role in shaping policy and practice.”
Ultimately, the ACS acknowledges the existence of differing opinions about trade-offs between benefits and harms of breast cancer screening and screening recommendations. The new recommendations are intended to provide only guidance to both women and health care professionals, leaving ample room for women’s personal values and preferences regarding screening to take precedence. Women are encouraged to continue to be aware of and discuss their family and medical history with their clinicians.
- Oeffinger KC et al. JAMA. 2015; doi: 10.1001/jama.2015.12783
- Keating NL, Pace LE. JAMA. 2015; doi: 10.1001/jama.2015.13086
- Myers ER et al. JAMA. 2015; doi: 10.1001/jama.2015.13183