The American Cancer Society has updated its breast cancer screening guidelines for women with average risk for developing breast cancer for the first time in over 10 years, according to an article published in the current issue of JAMA.1

“The new guideline provides women with a roadmap that is tailored to risk, screening intervals that offer greater protection against being diagnosed with an advanced breast cancer, and options where their values and preferences can contribute to decisions about when to begin screening and how often to be screened,” Robert Smith, PhD, vice president of cancer screening at the American Cancer Society told Cancer Therapy Advisor. “This advice is backed by the latest evidence.” 

The recommendations for women at average risk include1:

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  • Women should undergo regular mammography screening beginning at age 45.
  • Women between 45 to 54 years should be screened annually.
  • Women 55 years or older should be screened biennially or have the opportunity to continue screening annually.
  • Women should continue undergoing mammography screening as long as they have good overall health and a life expectancy of 10 years or longer.
  • Clinical breast examination is not recommended for screening at any age.
  • Women should be provided with information about breast cancer risk factors and  risk reduction, and the benefits, limitations, and harms associated with mammography screening.

The authors noted that periodic clinical breast examination is recommended for average-risk women at any age because there is a lack of clear evidence that it significantly impacted the detection of breast cancer before or after age 40.

These differ from the previous breast cancer screening guidelines for women at average-risk published in 2003, when the American Cancer Society recommended mammography annually starting at age 40 and a clinical breast exam every 3 years for women in their 20s and 30s and annually starting at age 40.2

Because of new data from long-term follow-up of randomized controlled trials and observations studies of population-based screening programs in women with breast cancer, Evan R. Myers, MD, MPH, of the Duke Clinical Research Institute in Durham, NC, and colleagues sought to update the American Cancer Society 2003 recommendations for average-risk women.1

The findings of their systematic review were published in JAMA as well. In addition, Diana L. Miglioretti, PhD, of the University of California Davis School of Medicine in Davis, CA, and colleagues sought to determine optimal mammography screening intervals by evaluating breast cancer outcomes for annual mammography compared those for biennial mammography. The results of that study appear in JAMA Oncology.

Ultimately, the guideline development group formulated their recommendations “based on the quality of evidence and judgment about the balance of benefits and harms of screening;” however, they encourage health care professionals to incorporate patients’ values and preferences in instances when the balance between the two is close.

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What do you think about the American Cancer Society’s updates on breast cancer screening?

“While some will be pleased with all or some of the features of the new guideline, others will disagree with all or some elements of the new guideline. But, we would save more lives if all women had access to regular mammograms without the burden of costs, and all women received timely reminders for regular mammograms,” Smith said. “Too many women are not getting screened and too many women are not getting screened regularly.”

The American Cancer Society estimates that about 231,840 new cases of invasive breast cancer will be diagnosed in the United States in 2015 and about 40,290 women will die from the disease, making it the second leading cause of cancer death in women after lung cancer.

Death rates from breast cancer have been declining for the last two decades, most likely due to improved treatment, as well as earlier detection through screening and increased awareness.3

Editor’s Note: The text of this article has changed since its original posting.

Reference

  1. Oeffinger KC, Fontham ETH, Etzioni R, et al. Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society [special communication October 20, 2015]. JAMA. 2015;314(15):1599-1614.
  2. Smith RA, Saslow D, Sawyer KA, et al. American Cancer Society guidelines for breast cancer screening: update 2003. CA Cancer J Clin. 2003; 53(3):141-169.
  3. Breast Cancer. American Cancer Society website. http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics. Updated June 10, 2015. Accessed October 19, 2015.

Topics:

Advanced Breast Cancer Breast Cancer