Women at average risk for breast cancer can wait to start getting mammograms until age 50 and be screened every other year, according to new guidelines from the American College of Physicians (ACP).

The guidelines, published yesterday online in Annals of Internal Medicine, are in line with longstanding recommendations from the US Preventive Services Task Force (USPSTF) that say average-risk women don’t need mammograms before 50 or annual screening.

“For average-risk women, without symptoms, getting screening mammograms every year as compared to every other year did not clearly improve outcomes while it did increase harms,” Dr. Ana Maria Lopez, president of the ACP, said by email.

The goal of screening mammography is to detect cancer when it’s easier to treat. But screening too early or too often can also catch more small, slow-growing tumours that are unlikely to be fatal—without curbing the diagnosis of advanced cancer cases, some previous research suggests.

“Unfortunately, we are currently unable to tell the difference between breast cancers that are over diagnosed vs the cancers that will be harmful to women, thus we recommend treatment for all,” said Dr. Joann Elmore, author of an accompanying editorial and a professor at the David Geffen School of Medicine at the University of California Los Angeles.

“Breast cancer is more common as women age and some of the harms of screening, such as false positives, are less common in older women, thus making the benefit increase and the harms reduced as women age,” Elmore said by email.

“Because of this, more national groups recommend starting screening in the 50s,” Elmore added. “When screening every year, the harms increase markedly, with less of an increase in the benefits, thus some groups now recommend screening every 2 years.”

For most women 40 to 49 years old, the potential harms of screening mammograms outweigh the possible benefits, according to the ACP guidelines.

Once women start getting mammograms, they should continue through age 74, the ACP recommends. After 75, or earlier for women with a life expectancy of 10 years or less, screening mammograms should stop, according to the ACP.

The American Cancer Society, however, says women ages 45 to 54 should get mammograms every year. Starting at 55, women can continue annual screening or switch to getting mammograms every other year, the cancer society advises.

It is the variation in guidelines that prompted the ACP to weigh in with recommendations of its own, said Dr. Amir Qaseem, vice president of clinical policy for the ACP.

“This highlights the critical role informed and shared decision making plays, and the need to incorporate a woman’s values and preferences in the screening decision regarding when to start screening,” Qaseem said by email.

SOURCE:  https://www.mdlinx.com/internal-medicine/top-medical-news/article/2019/04/09/7563400/

REFERENCE: Qaseem et al: Screening for Breast Cancer in Average-Risk Women: A Guidance Statement From the American College of Physicians; https://annals.org/aim/fullarticle/2730520/screening-breast-cancer-average-risk-women-guidance-statement-from-american