New guidelines for mammography

The American College of Physicians (ACP) has released a new clinical practice guideline for screening mammography for women 40 to 49 years of age.

The guideline, a background article, an editorial, and a patient summary appear in today's issue of Annals of Internal Medicine, published by ACP.

ACP developed the guideline to present the available evidence for screening mammography to physicians and women between the ages of 40 and 49 and to increase their understanding of the benefits and risks of screening mammography in women within this age group.

"We designed our screening mammography guideline based on scientific evidence," said Lynne Kirk, MD, FACP, President of ACP. "It will empower women between the ages of 40 and 49 to become part of the decision-making process and to encourage them to discuss with their physicians the benefits and risks of mammograms."

The guideline states that, according to the evidence studied, breast cancer risk is not evenly distributed in women between the ages of 40 and 49. Thus the benefits of screening mammography are not uniformly applicable in women in this age group. Therefore, women 40 to 49 years of age need to take into account their level of risk and the possible benefits and harms of screening mammography.

The main benefit of screening mammography is a decrease in breast cancer mortality. However, the risks associated with screening mammography include false-positive results, possible treatment for lesions that would not have become clinically significant, and radiation exposure.

"It is important to tailor the decision of screening mammography by discussing the benefits and risks with a woman, addressing her concerns, and making it a joint decision between her and her physician," said lead author Amir Qaseem, MD, PhD, MHA, Senior Medical Associate in the Clinical Programs and Quality of Care Department of the Medical Education and Publishing Division at ACP.

The guideline makes four recommendations for women between the ages of 40 and 49:

  • Clinicians should periodically perform individualized assessment of risk for breast cancer to help guide decisions about screening mammography.
  • Clinicians should inform women in this age group about the potential benefits and harms of screening mammography.
  • Clinicians should base screening mammography decisions on benefits and harms of screening as well as a woman's preferences and breast cancer risk profile.
  • ACP recommends further research on the net benefits and harms of breast cancer screening modalities for women in this age group.

"If a woman between the ages of 40 and 49 decides not to have a mammogram, she and her doctor should re-address the issue every one to two years," Kirk added.

In a separate editorial, Joann Elmore, MD, MPH, and John Choe, MD, MPRH, wrote: "In the face of continuing controversy about the evidence, our priority now should be to help women make informed decisions."

ACP's clinical guidelines are developed in an explicit, rigorous process based on extensive review of available scientific evidence. They are considered "evidence-based" rather than "expert-opinion" or consensus guidelines. In addition to publications from the original mammography trials, ACP reviewed 117 studies to evaluate the evidence about the risks and benefits of mammography screening for women between the ages of 40 and 49.


The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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