Breast Cancer Screening: ACP Releases Guidance Statements
Am Fam Physician. 2020 Feb 1;101(3):184-185.
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Key Points for Practice
• The most significant breast cancer screening benefit for women at average risk is from biennial mammograms from 50 to 74 years of age, which can decrease breast cancer–related deaths without affecting overall longevity.
• Annual mammogram screening increases false-positive results by 45% with little to no difference in outcomes.
• Starting screening at age 40 has a small effect on breast cancer mortality at the cost of increasing false-positive results by more than 60%.
• There is no mortality benefit to screening women 75 years or older or with a life expectancy less than 10 years because screening benefits are not seen for 11 years.
From the AFP Editors
Breast cancer is the fourth leading cause of cancer death in the United States and is the most common cancer type in women. Factors to consider for women who are at average risk for breast cancer include when to start or stop mammography, how often to be screened, and the effectiveness of clinical breast examination. The American College of Physicians (ACP) reviewed guidelines from other organizations and developed four statements to provide advice to clinicians about breast cancer screening for women who are at average risk. Average risk is defined for this guideline as no history of cancer or high-risk genetic mutation. Patients are considered at average risk independent of other personal risk factors. Overall, the most important risk factor for breast cancer is age.
AGE 50 TO 74 YEARS
Women 50 to 74 years of age should be screened with mammography biennially. Screening women 50 to 69 years of age reduces breast cancer mortality but not all-cause mortality. A benefit is less clear for women 70 to 74 years of age, but the best balance of benefits to harms for breast cancer screening is from 50 to 74 years of age.
Breast cancer screening annually has little to no difference in breast cancer mortality compared with biennial screening. False-positive results are common
Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.
This series is coordinated by Sumi Sexton, MD, editor-in-chief.
A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.
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