ACP now suggests breast cancer screening start at 50

The American College of Physicians (ACP) has changed its stance on breast screening. It now recommends women undergo mammography every other year, beginning at age 50, according to a new guidance statement published April 8 in the Annals of Internal Medicine.

A five-person panel, led by Amir Qaseem, MD, PhD, with the ACP, reviewed current breast cancer screening guidelines published between January 2013 and November 15, 2017. In total, the college published four guidance statements advising how to best screen average-risk women.

The guidance does explicitly state the new recommendations do not apply to patients with previous abnormal screening results or to women at higher than average risk, including an individual history of breast cancer or the genetic mutation associated with an increased risk.

“Beginning at age 40, average-risk women without symptoms should discuss with their physician the benefits, harms, and their personal preferences of breast cancer screening with mammography before the age of 50,” said ACP President Ana María López, MD, in an ACP statement. “The evidence shows that the best balance of benefits and harms for these women, which represents the great majority of women, is to undergo breast cancer screening with mammography every other year between the ages of 50 and 74.”

Additionally, the ACP suggests women of average breast cancer risk who are 75 years or older, or a life expectancy of 10 years or less, should stop breast cancer screening.

In response to the ACP’s new position, the American College of Radiology and the Society of Breast Imaging released a combined statement warning the new guidelines “would result in up to 10,000 additional, and unnecessary, breast cancer deaths in the United States each year.” The ACP’s screening guidelines would also “likely result in thousands more women enduring extensive surgery, mastectomies and chemotherapy for advanced cancers—and do little to nothing to address overdiagnosis or the harms of screening named in the ACP guidelines.”

Both organizations agree that women in good health should receive annual mammograms starting at age 40 and suggest women have a risk assessment by age 30 to determine if earlier screening would benefit them.