The American College of Obstetricians and Gynecologists (ACOG) recently published new breast cancer screening guidelines for women with an average risk of breast cancer. The guidelines were published in the July issue of the journal Obstetrics & Gynecology and stress the importance of women making the decision about the timing of breast cancer screening together with their healthcare practitioner.
"Our new guidance considers each individual patient and her values," said Christopher M. Zahn, MD, ACOG vice president of practice activities, in a press release. "Given the range of current recommendations," says Dr. Zahn, "we have moved toward encouraging obstetrician–gynecologists to help their patients make personal screening choices from a range of reasonable options."
The new guidelines recommend that for women of average risk, meaning no personal or family history of breast cancer and no other risk factors for breast cancer, the decision as to when to start and end screening for breast cancer as well as how often should be based on conversations about a woman’s health history and her preferences.
While new technologies to screen for breast cancer are currently in development, the most common tests are a physical exam by a trained health professional and a mammogram, a low-dose x-ray that allows specialists to look for changes in breast tissue.
The new ACOG guidelines recommend that women at average risk for breast cancer be offered screening mammograms starting at 40 years of age. If women choose to wait, they should start getting screened no later than age 50. When women of average risk decide to begin regular screening mammograms, they should have them every 1 to 2 years until age 75. After that, women should decide with their healthcare practitioner whether, and how often, to have a mammogram.
To make informed decisions about screening, women should receive information from their healthcare practitioner on the benefits as well as the harms of screening. While regular screening mammograms in average-risk women have reduced deaths from breast cancer, they can also lead to potential harms. These may include false-positive results (results that indicate breast cancer when none is present), increased anxiety, unnecessary follow-up testing (e.g., biopsies), detection of breast cancer that would not progress to cause symptoms (overdiagnosis) and overtreatment. Overdiagnosis and overtreatment can expose women to harms such as unnecessary surgery, chemotherapy and radiation therapy. After talking with their healthcare practitioners about their options, women are empowered to "fully consider their breast cancer screening options and take an active and informed role in their health care," according to ACOG.
While other organizations have guidelines that vary somewhat from ACOG's, they recognize the importance of personalized decisions:
- The US Preventive Services Task Force, a voluntary panel convened by the federal government whose recommendations are not binding, recommends mammograms every other year starting at age 50. Between ages 40 and 49, the decision should be made individually.
- The American Cancer Society says screening should be offered to women when they are 40 years old but recommends starting by age 45 years and continuing annually until age 55. At 55 years old, women can decide to continue having annual mammograms or decrease screening to every other year.
The new ACOG guidelines do not recommend breast self-exams for average risk women because the ACOG panel found that there is no evidence that self-exams are beneficial for patients. ACOG instead recommends that doctors speak with average-risk women about the normal look and feel of their breasts and advise each patient to contact their physician if she perceives changes, such as a mass, nipple discharge, redness or pain. Clinical breast exams, those performed by healthcare practitioners, can be offered to women ages 25 to 39 every one to three years and annually to women over 40 years old, according to ACOG.
The new ACOG guidelines do not offer recommendations for women at high risk of breast cancer or women with dense breasts who have a slightly higher risk than average-risk women of developing breast cancer.