American Cancer Society Updates Its Breast Cancer Screening Guidelines for Average-Risk Women
- The American Cancer Society (ACS) has updated its breast cancer screening guidelines for women at average risk of breast cancer, calling for yearly screening mammography starting at age 45 and biennial screenings for women 55 and older, continuing as long as their overall health is good and they have a life expectancy of 10 years or longer.
- The ACS no longer recommends routine clinical breast exams or breast self-exams for women at average risk because research shows they do not provide a clear benefit.
- The ACS guidelines provide evidence-based recommendations for breast cancer screening for women at average risk and should be considered by physicians and women in discussions about breast cancer screening.
After commissioning a systematic evidence review of the breast cancer screening literature to inform an update of its 2003 breast cancer screening interval guideline, the American Cancer Society (ACS) released new guidelines for women at average risk of breast cancer. The recommendations include yearly screening mammography starting at age 45 and biennial screenings for women 55 and older, continuing as long as their overall health is good and they have a life expectancy of 10 years or longer. The ACS is also no longer recommending clinical breast exams or self-exams.
The revised guidelines are based on new evidence accumulated from long-term follow-up of randomized controlled trials and observational studies of population-based screening programs. They also incorporate the assessment of balancing benefits and harms associated with screening. The guidelines are reported by Oeffinger et al in JAMA.
The ACS organized an interdisciplinary guideline development group consisting of clinicians (n = 4), biostatisticians (n = 2), epidemiologists (n = 2), an economist (n = 1), and patient representatives (n =2). The guideline development group developed five key questions using the general approach of specifying populations, interventions, comparisons, outcomes, timing of outcomes, and settings (PICOTS) for each question.
After evaluating available methods to grade the evidence and the strength of recommendations, the guideline development group selected the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system. The Duke University Evidence Synthesis Group was selected to conduct an independent systematic evidence review of the breast cancer literature.
In addition, the ACS commissioned the Breast Cancer Surveillance Consortium to update previously published analyses related to the screening interval and outcomes. The ACS Surveillance and Health Services Research Program provided supplementary data on disease burden using data from the Surveillance, Epidemiology, and End Results (SEER) Program.
The guideline development group chose to assess recommendations as “strong” or “qualified,” in accordance with GRADE guidance. A strong recommendation conveys the consensus that the benefits of adherence to that intervention outweigh the undesirable effects that may result from screening. Qualified recommendations indicate there is clear evidence of benefit of screening but less certainty about the balance of benefits and harms, or about patients’ values and preferences, which could lead to different decisions about screening.
Based on the guideline development group’s consensus judgment about when the benefits of mammography screening clearly or likely outweigh the harms in women at average risk, the ACS is recommending:
- Women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 (strong recommendation).
- Women aged 45 to 54 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).
“The ACS recommendations are made in the context of maximizing reductions in breast cancer mortality and reducing years of life lost while minimizing the associated harms among the population of women in the United States. The ACS recognizes that the balance of benefits and harms will be close in some instances and that the spectrum of women’s values and preferences will lead to varying decisions. The intention of this new guideline is to provide both guidance and flexibility for women about when to start and stop screening mammography and how frequently to be screened for breast cancer,” concluded the report’s authors.
Robert A. Smith, PhD, of the Cancer Control Department of the American Cancer Society is the corresponding author of this report.
Funding for this report was provided by the American Cancer Society. For full disclosures of the study authors, visit jama.jamanetwork.com.