American Academy of Family Physicians Updates Breast Cancer Screening Recommendations

Friday, January 15, 2010

Megan Moriarty
Public Relations Strategist
American Academy of Family Physicians
(800) 274-2237 Ext. 6052

LEAWOOD, Kan. — The American Academy of Family Physicians today revised its Recommendations for Clinical Preventive Services regarding breast cancer screening.

The new recommendations, based on the evidence report and recommendations developed by the U.S. Preventive Services Task Force, state that the decision to conduct screening mammography for women younger than 50 should be individualized and take into account potential risks, benefits and harms.

“Family physicians should discuss with each woman the possible consequences, benefits and risks, of breast cancer screening tests and develop a plan for early detection of breast cancer that minimizes potential harms,” said AAFP President Lori Heim, M.D. “In determining what is best for each individual patient, we as physicians need to discuss the patient’s risk of breast cancer, as well as the scientific evidence regarding the effectiveness of each screening test, to determine her preferences.”

The AAFP has utilized the rigorous, evidence-based clinical preventive services recommendations of the USPSTF as the basis for its recommendations for more than two decades, but before adopting the new recommendations, the AAFP thoroughly reviewed the matter.

“The AAFP was mindful of the concerns that have been raised since the release of the new USPSTF breast cancer recommendations. It is important to recognize that the recommendations do not bring an end to screening in women ages 40 to 49, but promote individualized care by having physicians speak with women about their medical history and whether mammography is right for them,” Heim said.

More specifically, the updated recommendations state that:

  • The AAFP recommends that the decision to conduct screening mammography before age 50 should be individualized and discussed between the patient and her physician, taking into account patient context including her risks as well as her values regarding specific benefits and harms.
  • The AAFP recommends mammography screening every two years for women between ages 50 and 74.
  • The AAFP recommends against clinicians teaching women breast self examination.
  • The AAFP concludes that the current evidence is insufficient to assess the benefits and harms of screening mammography in women aged 75 years and older.
  • The AAFP concludes that the current evidence is insufficient to assess the benefits and harms of clinical breast examination for women aged 40 years and older.
  • The AAFP concludes that current evidence is insufficient to assess benefits and harms of either digital mammography or MRI instead of film screen mammography as screening modalities for breast cancer.

These recommendations are intended to apply to women who are not at increased risk of developing breast cancer and only apply to routine screening procedures.

But for those women at normal risk, less than 50 years of age, there can be negative aspects to regular screening for breast cancer, such as unnecessary imaging tests and biopsies in women without cancer, as well as the inconvenience and the psychological harms due to false-positive screening results. False-positive results are more common for women aged 40 to 49 years.

For older women, over diagnosis is a greater likelihood. The updated recommendations ask physicians and patients to consider the harms associated with treatment of cancer that would not become clinically apparent during a woman’s lifetime, as well as the harms of unnecessary earlier treatment of breast cancer that would have become clinically apparent but would not have shortened a woman’s life.

Breast cancer is the second-leading cause of cancer death among women in the United States. Screening is a valuable tool in detecting and successfully treating breast cancer and should be considered individually between a patient and their physician.

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Founded in 1947, the American Academy of Family Physicians represents 134,600 physicians and medical students nationwide, and it is the only medical society devoted solely to primary care.

Family physicians conduct approximately one in five of the total medical office visits in the United States per year – more than any other specialty. Family physicians provide comprehensive, evidence-based, and cost-effective care dedicated to improving the health of patients, families and communities. Family medicine’s cornerstone is an ongoing and personal patient-physician relationship where the family physician serves as the hub of each patient’s integrated care team. More Americans depend on family physicians than on any other medical specialty.

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