ACP recommends biennial mammography for women aged 50 to 74

New guidance from the American College of Physicians (ACP) says all asymptomatic, average-risk females ages 50 to 74 should receive biennial screening mammography for breast cancer. Females between the ages of 40 and 49 should discuss with their doctor their risk for breast cancer and the benefits and harms of screening. This is because harms of screening such as false positive results, psychological distress because of it, overdiagnosis, overtreatment, additional testing, and radiation exposure may outweigh the uncertain benefits in this population. ACP's advice, "Screening for Breast Cancer in Asymptomatic, Average-Risk Adult Females: A Guidance Statement from the American College of Physicians", is published in Annals of Internal Medicine. 

ACP also provides guidance on when to discontinue breast cancer screening and how to approach screening for females with dense breasts. ACP says that asymptomatic, average‑risk females who are 75 years or older, or those with a limited life expectancy, 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. 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. However, ACP advises against using supplemental MRI or ultrasound for screening in this population. 

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 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, or a history of high-dose radiation therapy to the chest at a young age. 

"Screening for breast cancer is essential and should be guided by the best available evidence" said Jason M. Goldman, MD, MACP, President of ACP. "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."