Breast cancer is the most common cancer in women worldwide, and second only to lung cancer
as a cause of cancer death in the United States.
Screening mammography detects breast cancer early and is associated with a reduction
in breast cancer mortality But accumulating evidence suggests it can cause at least
as much harm as benefit in some women.
Those harms include false positive findings that lead to unnecessary worry, imaging, and biopsy
And overdiagnosis and overtreatment when screening detects indolent cancers
that would never have become symptomatic and would never have needed treatment
if they hadn't been found on screening.
Growing recognition of those harms led The American Cancer Society
to organize an expert panel of physicians, scientists, and patient representatives
to update the Society's recommendations for breast cancer screening to account
for the tradeoffs between benefits and harms of breast cancer screening,
and for the personal preferences women may have about when and how often
to undergo screening given those tradeoffs.
The updated guideline applies to women at average risk of breast cancer Meaning,
those with no personal history of breast cancer no genetic susceptibility to breast cancer,
And no history of chest radiation treatment,
such as for childhood cancer The guideline recommends
that average-risk women begin screening mammography starting
at age 45 Undergo annual screening exams for 10 years Transition to every-other-year screening
at age 55 And continue every-other-year screening as long
as their overall health is good AND they have a life expectancy of 10 years or more.
The guideline qualifies the recommendation to say that women can be given the option
to begin annual screening at age 40 And continue annual rather
than every other year screening beyond age 55, if they prefer or if their doctors recommend it.
Finally, the American Cancer Society recommends against physician breast examination as a means
to screen for breast cancer because of the lack of evidence
that physical examination improves patient outcomes.
The guideline acknowledges a host of uncertainties about the science
of breast cancer screening So it gives women a framework for when to start and stop screening,
and how frequently to be screened.
while giving women flexibility of choice within that framework And they encourage all women
at average risk of breast cancer to become familiar with the potential benefits
and harms associated with breast cancer screening so they
and their physicians can make the decision that's best for them.