New guidance outlines screening considerations for women in their 40s, use of DBT for dense breasts, and when to stop screening.
The American College of Physicians (ACP) has issued new guidance recommending biennial screening mammography for asymptomatic, average-risk women ages 50 to 74. The guidance was published in Annals of Internal Medicine.
For women ages 40 to 49, ACP recommends individualized decision-making based on a discussion of breast cancer risk and the potential benefits and harms of screening. The organization notes that potential harms—including false positives, overdiagnosis, overtreatment, additional testing, psychological distress, and radiation exposure—may outweigh uncertain benefits for some patients in this age group.
The guidance also addresses when to discontinue screening. ACP advises that women age 75 and older, or those with limited life expectancy, should consider stopping routine screening after discussing with their physician. According to ACP, the benefits of screening beyond age 74 are reduced or uncertain, while the likelihood of harms such as overdiagnosis increases.
For women with dense breasts, ACP recommends considering supplemental digital breast tomosynthesis (DBT), with decisions based on potential benefits and harms, radiation exposure, availability, patient preferences, and cost. The guidance advises against the use of supplemental MRI or ultrasound for screening in average-risk patients with dense breasts.
ACP defines average risk as individuals without a personal history of breast cancer or high-risk breast lesions, known genetic mutations such as BRCA1 or BRCA2, a familial breast cancer syndrome, or prior high-dose chest radiation at a young age.
“Screening for breast cancer is essential and should be guided by the best available evidence,” says Jason M. Goldman, MD, MACP, president of ACP, in a statement. “This guidance is intended to support informed decisions about when to start and stop screening, screening intervals, and modality selection.”
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