New Breast Cancer Screening Guidance from the American College of Physicians

The American College of Physicians (ACP) has published new guidance on breast cancer screening for asymptomatic, average-risk adult females in Annals of Internal Medicine.

Who is Considered "Average Risk"?

The ACP's Clinical Guidelines Committee defined average risk as females without:

• A personal history of breast cancer or diagnosis of a high-risk breast lesion.
• A genetic mutation (e.g., BRCA1 or BRCA2) known to increase risk.
• Another familial breast cancer risk syndrome.
• A history of high-dose radiation therapy to the chest at a young age.

Core Screening Recommendations by Age

Ages 50 to 74

• Biennial screening mammography is recommended.

Ages 40 to 49

• A discussion with a doctor about personal risk and the benefits and harms of screening is advised.

• The ACP notes that potential harms, such as false positives, psychological distress, overdiagnosis, overtreatment, additional testing, and radiation exposure, may outweigh uncertain benefits in this age group.

Ages 75 and Older

• A discussion with a doctor about stopping routine screening is advised.

• Benefits beyond age 74 are reduced or uncertain and potential harms become more likely, particularly for those with a limited life expectancy.

Guidance for Individuals with Dense Breasts

For asymptomatic, average-risk females with dense breasts, the ACP advises doctors to consider supplemental digital breast tomosynthesis (DBT). Decisions should consider potential benefits, harms, radiation exposure, availability, patient values, preferences, and cost.

The ACP advises against using supplemental MRI or ultrasound for screening in this population.

Official Statement

"Screening for breast cancer is essential and should be guided by the best available evidence. ACP developed this guidance to provide physicians and females with the information they need to make breast cancer screening decisions, including when to start and discontinue, how often to screen, and which methods to use for screening."

— Jason M. Goldman, MD, MACP, President of the ACP