Family physicians may soon be fielding more questions from their female patients on when and how often they should be screened for breast cancer. That's because the American Cancer Society (ACS) recently released an updated screening guideline(www.cancer.org) that recommends women at average risk start annual screening with mammography at age 45 and transition to screening every two years at age 55.
The ACS recommendation conflicts with draft recommendations(screeningforbreastcancer.org) released in April by the U.S. Preventive Services Task Force (USPSTF) that reaffirmed its 2009 recommendations calling for screening women ages 50-74 with mammography every two years and those younger than 50 on an individualized basis after weighing the benefits and harms of biennial screening. The USPSTF also concluded there is insufficient evidence to recommend for or against screening women age 75 or older.
The AAFP's current breast cancer screening recommendations mirror those the task force finalized in 2009.
Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, told AAFP News that any screening recommendation has to be based on an evaluation of the evidence available, weighing the benefits and harms of the procedure.
"Although it makes sense to most that early detection of cancer is a good thing, it is not that simple," she said. "The evidence shows that the false-positive rate is highest in women younger than age 50 and in women who have annual screening."
According to Frost, lowering the recommended age for regular breast cancer screening would lead to more patients being exposed to additional tests and procedures, including biopsy. Also, starting earlier and having more frequent mammograms increases the risk of radiation-induced cancer, she said.
"Screened women are more likely to have surgical and radiation therapy, both of which have significant potential risks," said Frost. "And although screening for breast cancer reduces overall breast cancer mortality, the evidence has borderline statistical significance, and the all-cause mortality is not reduced."
According to an Oct. 20 news release,(pressroom.cancer.org) the ACS guideline was developed by the ACS Guideline Development Group, a panel of generalist clinicians, biostatisticians, epidemiologists, economists and patient representatives convened by the organization. The guideline development group commissioned a systematic review of the evidence from the Duke University Evidence Synthesis Group to inform the recommendation process.
Based on that evidence review, the panel concluded that there is a benefit from mammography screening for women in their early 40s, while acknowledging that risks for this group included the aforementioned false-positive results.
No matter the gap between their respective recommendations, one thing the AAFP and the ACS agree on is recommending shared decision-making.
"Have a conversation with your patient and find out what is most important to her," Frost said. "And remember, these recommendations are for women at average risk for breast cancer, not women at increased risk."
Related AAFP News Coverage
USPSTF Still Recommends Mammography for Women 50-74
Screening for Women in Their 40s Remains Based on Risk Factors