The American College of Physicians (ACP) announced on Apr. 17 new guidance recommending that all asymptomatic, average-risk females ages 50 to 74 undergo biennial screening mammography for breast cancer. The recommendations also advise that females between the ages of 40 and 49 discuss their individual risk factors and the potential benefits and harms of screening with their doctor.
The updated guidelines aim to help patients and physicians make informed decisions about breast cancer screening, balancing the benefits of early detection against possible harms such as false positives, psychological distress, overdiagnosis, overtreatment, additional testing, and radiation exposure. According to ACP, these harms may outweigh uncertain benefits in younger women.
The guidance statement was developed by ACP's Clinical Guidelines Committee and published in Annals of Internal Medicine. It defines average risk as females without a personal history of breast cancer or high-risk lesions, genetic mutations like BRCA1 or BRCA2 known to increase risk, other familial syndromes related to breast cancer risk, or a history of high-dose chest radiation at a young age.
For women aged 75 years or older or those with limited life expectancy who are asymptomatic and at average risk, ACP advises discussing discontinuation of routine screening with their physician due to reduced or uncertain benefit beyond age 74 and increased likelihood of harm such as overdiagnosis. For those with dense breasts in this population group, doctors are advised to consider supplemental digital breast tomosynthesis (DBT), taking into account potential benefits and harms along with patient preferences and cost; however, ACP advises against using supplemental MRI or ultrasound for routine screening in these cases.
"Screening for breast cancer is essential and should be guided by the best available evidence," said Jason M. Goldman, MD, MACP, President of ACP. "ACP developed this guidance to provide physicians and females with the information they need to make breast cancer screening decisions, including when to start and discontinue, how often to screen, and which methods to use for screening."
