Breast screening should be offered to women starting at age 40, but screening should start only after a woman discusses the best age at which to begin with her physician, according to updated guidelines released June 22 by the American College of Obstetricians and Gynecologists (ACOG).
The updated guidelines represent a double-edged sword for mammography proponents. On the positive side, ACOG continues to support 40 as the age at which mammography should be considered, in line with imaging groups such as the American College of Radiology and the Society of Breast Imaging. On the negative side, ACOG no longer backs routine mammography starting at 40, instead recommending that a shared decision-making process begin at that time.
The updated guidelines begin by noting that research supports the idea that mammography screening starting at age 40 reduces breast cancer mortality in average-risk women. However, breast screening also involves potential harms, including anxiety, overdiagnosis, and false-positives, according to ACOG.
The debate over mammography's benefits and harms has led to changes in screening guidelines that create challenges for both patients and providers in choosing the best approach, ACOG noted. The society therefore has shifted to guidelines that emphasize communication between physicians and women in their 40s, when the benefits of mammography are less clear compared to the benefits in older women.
"Given the range of current recommendations, we have moved toward encouraging obstetrician-gynecologists to help their patients make personal screening choices from a range of reasonable options," said Dr. Christopher Zahn, vice president of practice activities at ACOG, in a prepared statement.
The guidelines include the following recommendations:
- Breast screening should be offered to women at average risk of cancer starting at age 40. When to actually start screening should be determined as part of a decision-making process between a woman and her physician that includes discussion of the benefits and harms of mammography.
- Women should start screening mammography no later than age 50.
- Screening should take place every one or two years for women at average risk of breast cancer, with the actual frequency based on a shared decision-making process.
- Screening should continue through age 75 for women at average risk of breast cancer. Whether to continue past age 75 should be decided based on a woman's health status and longevity.
The new guidelines are the result of a review that ACOG began with a January 2016 conference. A review of the updated guideline is available by clicking here.
