Health and Me

Rachel V Thomas

New Breast Cancer Guidelines Recommend Mammograms Every Two Years for Women

The new <a href="https://www.healthandme.com/health/breast-cancer">breast cancer</a> screening guidelines released by the American College of Physicians (ACP) call for mammography screening once every two years in asymptomatic, average-risk adult females, instead of the annual recommendation.

ACP is the largest medical specialty organization in the United States with members in more than 172 countries worldwide. 

The guidance statement was developed by ACP's Clinical Guidelines Committee, which defined average risk as females 

<ul><li>who do not have a personal history of breast cancer or a diagnosis of a high-risk breast lesion, </li><li>a genetic mutation such as BRCA 1 or 2 that is known to increase risk, </li><li>another familial breast cancer risk syndrome, </li><li>a history of high-dose radiation therapy to the chest at a young age.</li></ul>

While the annual mammography has long been considered the standard, in a paper published in Annals of Internal Medicine, the ACP authors explained that the changes have been made to tackle the harms caused by false positive results and the resulting psychological distress.

The false positive results can lead to "overdiagnosis, overtreatment, additional testing, and radiation exposure, and may outweigh the uncertain benefits in this population,” said the ACP.

Also read: <a href="https://www.healthandme.com/health-news/breast-cancer-screening-ai-integration-to-help-predict-the-risks-better-article-154098318" data-type="tilCustomLink">Breast Cancer Screening: AI May Predict Tumors Before Mammograms Can Detect Them</a>

<h2>Mammography For Breast Cancer: What Did The Guidelines Say </h2>

<ul><li>The ACP stated that all average-risk females ages 50 to 74 should receive biennial screening mammography for breast cancer. </li></ul>

<ul><li>It urged females between the ages of 40 and 49 to discuss with their doctor their risk for breast cancer and the benefits and harms of screening. </li></ul>

<ul><li>The guidelines stated that asymptomatic, average-risk females who are 75 years or older, or those with a limited life expectancy, can discuss stopping routine screening with their doctor.</li></ul>

"This is because the benefits of screening beyond age 74 are reduced or uncertain, while potential harms, such as overdiagnosis, become more likely with increasing age," it said.

<ul><li>Further, for asymptomatic, average-risk females who have dense breasts, ACP advises doctors to consider supplemental digital breast tomosynthesis (DBT). </li></ul>

"Decisions should consider potential benefits and harms, radiation exposure, availability, patient values and preferences, and cost," the ACP said, while advising against using supplemental MRI or ultrasound for screening in this population.

Breast cancer is one of the leading causes of death in 40–49-year-old women in the United States, and screening is specifically performed to prevent death from breast cancer. 

Screening only women ages 50-74 every other year – as called for by ACP – may result in up to 10,000 additional, and unnecessary, breast cancer deaths in the United States each year, said the American College of Radiology (ACR) and the Society of Breast Imaging (SBI) in a joint statement.

Also read: <a href="https://www.healthandme.com/health-wellness/whats-the-confusion-why-most-women-dont-know-when-to-start-mammogram-screenings-article-152291430" data-type="tilCustomLink">What's The Confusion! Why Most Women Don’t Know When To Start Mammogram Screenings?</a>

Calling the new guidelines “outdated and hyperbolic information”, the statement noted that it will cause continued confusion among women. 

"Thousands more women would endure extensive surgery, mastectomies, and chemotherapy for advanced cancers than if their cancers were found early by an annual mammogram,” it said. 

Current guidelines from the ACR and the SBI urge women to start annual screening at age 40. 

The ACR also recommends that women have a breast cancer risk assessment by age 25. Those at higher risk for breast cancer should talk to their doctor about starting screening before age 40 and additional screening methods -- particularly those with genetic mutations or a strong family history of breast cancer. 

The United States Preventive Services Task Force (USPSTF) also urges starting annual screening at age 40 to save lives.

Further, the statement also called out ACP for its failure to recommend exams beyond digital breast tomosynthesis (DBT) for screening women with dense breasts. The statement said this "is also out of step with current research, which shows the need to go beyond DBT to help find cancer in these women".

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american college of radiology

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The new breast cancer screening guidelines released by the American College of Physicians (ACP) call for mammography screening once every two years in asymptomatic, average-risk adult females, instead of the annual recommendation. ACP is the largest medical specialty organization in the United States with members in more than 172 countries worldwide. The guidance statement was developed by ACP's Clinical Guidelines Committee, which defined average risk as females who do not have a personal history of breast cancer or a diagnosis of a high-risk breast lesion, a genetic mutation such as BRCA 1 or 2 that is known to increase risk, another familial breast cancer risk syndrome, a history of high-dose radiation therapy to the chest at a young age.While the annual mammography has long been considered the standard, in a paper published in Annals of Internal Medicine, the ACP authors explained that the changes have been made to tackle the harms caused by false positive results and the resulting psychological distress. The false positive results can lead to "overdiagnosis, overtreatment, additional testing, and radiation exposure, and may outweigh the uncertain benefits in this population,” said the ACP.Also read: Breast Cancer Screening: AI May Predict Tumors Before Mammograms Can Detect ThemMammography For Breast Cancer: What Did The Guidelines Say  The ACP stated that all average-risk females ages 50 to 74 should receive biennial screening mammography for breast cancer. It urged females between the ages of 40 and 49 to discuss with their doctor their risk for breast cancer and the benefits and harms of screening. The guidelines stated that asymptomatic, average-risk females who are 75 years or older, or those with a limited life expectancy, can discuss stopping routine screening with their doctor."This is because the benefits of screening beyond age 74 are reduced or uncertain, while potential harms, such as overdiagnosis, become more likely with increasing age," it said. Further, for asymptomatic, average-risk females who have dense breasts, ACP advises doctors to consider supplemental digital breast tomosynthesis (DBT). "Decisions should consider potential benefits and harms, radiation exposure, availability, patient values and preferences, and cost," the ACP said, while advising against using supplemental MRI or ultrasound for screening in this population. Why Experts Are Disagreeing Breast cancer is one of the leading causes of death in 40–49-year-old women in the United States, and screening is specifically performed to prevent death from breast cancer. Screening only women ages 50-74 every other year – as called for by ACP – may result in up to 10,000 additional, and unnecessary, breast cancer deaths in the United States each year, said the American College of Radiology (ACR) and the Society of Breast Imaging (SBI) in a joint statement. Also read: What's The Confusion! Why Most Women Don’t Know When To Start Mammogram Screenings?Calling the new guidelines “outdated and hyperbolic information”, the statement noted that it will cause continued confusion among women. "Thousands more women would endure extensive surgery, mastectomies, and chemotherapy for advanced cancers than if their cancers were found early by an annual mammogram,” it said. Current guidelines from the ACR and the SBI urge women to start annual screening at age 40. The ACR also recommends that women have a breast cancer risk assessment by age 25. Those at higher risk for breast cancer should talk to their doctor about starting screening before age 40 and additional screening methods -- particularly those with genetic mutations or a strong family history of breast cancer. The United States Preventive Services Task Force (USPSTF) also urges starting annual screening at age 40 to save lives.Further, the statement also called out ACP for its failure to recommend exams beyond digital breast tomosynthesis (DBT) for screening women with dense breasts. The statement said this "is also out of step with current research, which shows the need to go beyond DBT to help find cancer in these women".