May 19, 2016
The American Cancer Society (ACS) (1) and the U.S. Preventive Services Task Force (USPSTF) (2) have recently updated their recommendations for breast cancer screening in average-risk women. Both guidelines are based on systematic reviews of the existing evidence regarding the benefits and harms of routine breast cancer screening. The ACS and USPSTF guidelines both highlight the benefits of routine screening and emphasize the need for shared decision making between patients and health care providers, although their recommendations differ in some areas.
The American College of Obstetricians and Gynecologists (the College) is reviewing these new guidelines and the evidence upon which they are based to evaluate the need to update its breast cancer screening recommendations (3). The review will focus on screening mammography and the role of the clinical breast examination in screening for breast cancer, which both ACS and USPSTF no longer recommend. To address the need for harmony among recommendations, in January 2016 the College convened a multidisciplinary forum. Participants in the conference included representatives from 30 organizations representing women’s health care providers, radiologists, patient advocate organizations, and allied women’s health professional communities. Patient representatives also provided valuable input. It is hoped that the outcome of this discussion will assist informed decision making among women and their health care providers.
In the interim, the College continues to underscore the following key points about routine breast cancer screening:
Screening mammography decreases mortality from breast cancer.
Health care providers should assess breast cancer risk and discuss breast cancer screening with all women.
For women at average risk, health care providers should discuss the benefits and harms of screening mammography starting at age 40 years.
Health care providers should work with patients to determine the best screening strategy based on individual risk and values. In some women, biennial screening may be a more appropriate or acceptable strategy. Some average-risk women may prefer biennial screening, which maintains most of the benefits of screening while decreasing both the frequency of screening and the potential for additional testing, whereas other women may prefer annual screening because it maximizes cancer detection.
Regardless of the screening approach that is followed, the College continues to emphasize the importance of mammography and its role in early detection of breast cancer and consequent reduction in mortality. The decision of when to start screening, the frequency of screening, and when to end screening should be made through shared decision making, with consideration of individual patient values and preferences about the potential benefits and consequences of screening.
Oeffinger KC, Fontham ET, Etzioni R, Herzig A, Michaelson JS, Shih YC, et al. Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society [published erratum appears in JAMA 2016;315:1406]. JAMA 2015;314:1599-614. Available at: http://jama.jamanetwork.com/article.aspx?articleid=2463262. Retrieved May 19, 2016. PMID: 26501536.
Siu AL. Screening for breast cancer: U.S. Preventive Services Task Force Recommendation Statement. U.S. Preventive Services Task Force. Ann Intern Med 2016;164:279-96. Available at: http://annals.org/article.aspx?articleid=2480757. Retrieved May 19, 2016. PMID: 26757170.
Breast cancer screening. Practice Bulletin No. 122. American College of Obstetricians and Gynecologists. Obstet Gynecol 2011;118:372–82. Available at http://www.acog.org/Resources-And-Publications/Practice-Bulletins/Committee-on-Practice-Bulletins-Gynecology/Breast-Cancer-Screening. Retrieved May 19, 2016. PMID: 21775869.
A Practice Advisory is issued when information on an emergent clinical issue (e.g. clinical study, scientific report, draft regulation) is released that requires an immediate or rapid response, particularly if it is anticipated that it will generate a multitude of inquiries. A Practice Advisory is a brief, focused statement issued within 24-48 hours of the release of this evolving information and constitutes ACOG clinical guidance. A Practice Advisory is issued only online for Fellows but may also be used by patients and the media. Practice Advisories are reviewed periodically for reaffirmation, revision, withdrawal or incorporation into other ACOG guidelines.
This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed.
The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation's leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 58,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. www.acog.org