ACP shares new breast cancer screening guidelines, imaging societies push back

The American College of Physicians (ACP) now recommends that average-risk women with no symptoms undergo breast cancer screening with mammography every other year, beginning at the age of 50. The ACP explained its decision through a new guidance statement published in Annals of Internal Medicine.

“Beginning at age 40, average-risk women without symptoms should discuss with their physician the benefits, harms, and their personal preferences of breast cancer screening with mammography before the age of 50,” ACP President Ana María López, MD, said in a prepared statement. “The evidence shows that the best balance of benefits and harms for these women, which represents the great majority of women, is to undergo breast cancer screening with mammography every other year between the ages of 50 and 74.”

The ACP emphasized that these recommendations do not apply to women at a higher risk of breast cancer or anyone with prior abnormal screening results. Harms associated with breast cancer screening, according to the ACP, include “false positive results (from a test showing an abnormality even though the woman does not have breast cancer), overdiagnosis, overtreatment, radiation exposure, and radiation associated breast cancers and breast cancer deaths, as well as worry and distress from tests and procedures including breast biopsies.”

The ACP’s statement also noted that more women screened annually receive abnormal results (7%) than women screened every other year (4.8%).

The American College of Radiology (ACR) and Society of Breast Imaging (SBI) issued a response to the ACP guidance statement, noting that such recommendations “may result in up to 10,000 additional, and unnecessary, breast cancer deaths in the United States each year.” Also, according to the two imaging societies, the recommendations could “likely result in thousands more women enduring extensive surgery, mastectomies and chemotherapy for advanced cancers.”

The ACR/SBI response also notes that the ACP’s recommendations “fail to address” demographic groups at an increased risk of developing breast cancer. “The ACP approach may exacerbate racial disparities in breast cancer outcomes,” according to the statement.