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Breast Cancer Screening Guideline
ACS guideline says screen later, less often
The American Cancer Society’s (ACS) updated breast cancer screening guideline for women at average risk for breast cancer recommends that women should start getting mammograms at age 45 years instead of 40 and that these screenings may not be needed as often. Among the ACS recommendations for women at average risk of breast cancer are:
• Women should undergo regular screening mammography starting at age 45 years.
• Women aged 45 to 54 years should be screened annually.
• Women aged 55 years and older should transition to biennial screening or have the opportunity to continue screening annually.
• Women should have the opportunity to begin annual screening between the ages of 40 and 44 years.
• Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer.
• Clinical breast examination for breast cancer screening among average-risk women at any age is not recommended.
Citation: Oeffinger KC, Fontham ETH, Etzioni R, et al. Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society. JAMA. 2015;314(15):1599-1614. doi: 10.1001/jama.2015.12783.
Commentary: The main change, to begin screening at age 45 instead of age 40, is based on the fact that the 5-year risk of breast cancer risk is similar in the 45- to 50-year-old age group and the 50- to 55-year-old age group, 0.9% and 1.1% risk, respectively. The 5-year risk in both these age groups is greater than that in the 40- to 44-year-old age group where the risk is 0.9%. These new recommendations also carefully weigh the risks of mammography, particularly the risk of false positive mammography leading to unnecessary biopsies. The 10-year likelihood of a false positive biopsy is 7.0% with annual mammography and decreases to 4.8% with every other year mammography. A change to every other year screening after age 55 would decrease the risk of need for a biopsy by about one-third. Even with the new recommendations, some women will opt for earlier and more frequent screening and the new ACS recommendations allow for these personal preferences. —Neil Skolnik, MD