New Guidelines: Mammogram Every 2 Years after Age 50 for Those at Average Risk

The American College of Physicians (ACP) released new guidelines recommending that women aged 50 to 74 years at average risk of breast cancer receive a mammogram every other year. This recommendation is also endorsed by the U.S. Preventive Services Task Force.

“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,” Ana María López, MD, president of the ACP, told Reuters.

We should move away from average risk in screening for any conditions unless prevalence is high in particular population. Polygenic risk score is needed to recommend for routine screening. Aren’t we familiar with wasteful average risk screening in cardiology @EricTopol ? https://t.co/RCotvMCSGH

— DrNithi (@DrNithi) April 10, 2019

Updated recommendations

The new guidance also notes that in women 40 to 49 years at average risk, clinicians should discuss whether to screen for breast cancer with mammography before age 50. In women 75 years and older at average risk who have a life expectancy of 10 years or less, clinicians should discontinue screening for breast cancer. In average-risk women of all ages, clinicians should not use clinical breast examination to screen for breast cancer.

The ACP recommendations were derived from an analysis of seven English-language guidelines addressing breast cancer screening and published between January 1, 2013, and November 15, 2017. Researchers used the AGREE II (Appraisal of Guidelines for Research and Evaluation II) instrument to evaluate the quality of guidelines.

USPSTF -> age 50-74 Biennial@AmericanCancer -> age 45 annual, then age 55 Biennial @ACPinternists -> age 50-74 Biennial
So, while differences are there, ACP is not an outlier#mammogram @pennstate2003 @DrLen https://t.co/nbLBQtHJ4j

— William Fox (@BillFoxMD) April 9, 2019

Some medical groups disagree

However, radiology groups, including the American College of Radiology (ACR) and Society of Breast Imaging (SBI), dissented the new guidelines, and recommend that women have annual mammograms starting at 40 years of age and continue “as long as they are in good health.” The American Cancer Society also recommends starting mammography at 40 years of age.

In a joint statement, ACR and SBI said that these new recommendations “may result in up to 10,000 additional, and unnecessary, breast cancer deaths in the United States each year.”