ACS Updates Screening Mammography Guidelines
For the first time since 2003, the American Cancer Society (ACS) has updated its breast cancer screening guidelines for women at an average risk of developing the disease. The guidance is published in the October 20 issue of JAMA.
“The biggest change in the guidelines and the one that will be noticed the most is that we now recommend women start annual screening at age 45,” said guideline author Elizabeth T.H. Fontham, MPH, DrPH, professor of epidemiology and founding dean of Louisiana State University Health Sciences Center School of Public Health, New Orleans.
“Previously we recommended that women start screening with mammography at age 40, but the guideline development group has carefully examined the data and the burden of disease among women ages 40 to 54 is not uniform,” she said in a JAMA audio interview. “The group concluded that the risk of cancer is lower for women aged 40 to 44 in terms of incidence and the risk of a false positive is somewhat higher. So a direct recommendation to begin screening at 40 was no longer warranted.”
While annual screening is recommended for women aged 45 to 54 years, the new guidelines recommend that at age 55, women should transition to screening every 2 years instead of annually.
Women should also continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer. “Previously we didn’t discuss screening after age 75,” explained Dr Fontham. “These recommendations offer a more tailored guidance rather than a ‘one-size-fits-all,’ based on a woman’s age, health personal preferences, and so on.”
The ACS also does not recommend clinical breast examination for breast cancer screening among average-risk women at any age.
These recommendations represent guidance from the ACS for women at average risk for breast cancer, which includes women without a personal history of breast cancer, a suspected or confirmed genetic mutation known to increase risk for breast cancer, or a history of previous radiotherapy to the chest at a young age.
The ACS also recommends that all women should become familiar with the potential benefits, limitations, and harms associated with breast cancer screening.
- Women with an average risk for breast cancer should undergo regular screening mammography starting at age 45 years (strong recommendation).
- Women aged 45 to 54 years should be screened annually (qualified recommendation).
- Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation).
- Women should have the opportunity to begin annual screening between the ages of 40 and 44 years (qualified recommendation).
- Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer (qualified recommendation).
- The ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age (qualified recommendation).