Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society.

Oeffinger KC1, Fontham ET2, Etzioni R3, Herzig A4, Michaelson JS5, Shih YC6, Walter LC7, Church TR8, Flowers CR9, LaMonte SJ10, Wolf AM11, DeSantis C12, Lortet-Tieulent J12, Andrews K12, Manassaram-Baptiste D12, Saslow D12, Smith RA12, Brawley OW12, Wender R12; American Cancer Society.

Author information

Abstract

IMPORTANCE:

Breast cancer is a leading cause of premature mortality among US women. Early detection has been shown to be associated with reduced breast cancer morbidity and mortality.

OBJECTIVE:

To update the American Cancer Society (ACS) 2003 breast cancer screening guideline for women at average risk for breast cancer.

PROCESS:

The ACS commissioned a systematic evidence review of the breast cancer screening literature to inform the update and a supplemental analysis of mammography registry data to address questions related to the screening interval. Formulation of recommendations was based on the quality of the evidence and judgment (incorporating values and preferences) about the balance of benefits and harms.

EVIDENCE SYNTHESIS:

Screening mammography in women aged 40 to 69 years is associated with a reduction in breast cancer deaths across a range of study designs, and inferential evidence supports breast cancer screening for women 70 years and older who are in good health. Estimates of the cumulative lifetime risk of false-positive examination results are greater if screening begins at younger ages because of the greater number of mammograms, as well as the higher recall rate in younger women. The quality of the evidence for overdiagnosis is not sufficient to estimate a lifetime risk with confidence. Analysis examining the screening interval demonstrates more favorable tumor characteristics when premenopausal women are screened annually vs biennially. Evidence does not support routine clinical breast examination as a screening method for women at average risk.

RECOMMENDATIONS:

The ACS recommends that women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 years (strong recommendation). Women aged 45 to 54 years should be screened annually (qualified recommendation). Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation). Women should have the opportunity to begin annual screening between the ages of 40 and 44 years (qualified recommendation). Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer (qualified recommendation). The ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age (qualified recommendation).

CONCLUSIONS AND RELEVANCE:

These updated ACS guidelines provide evidence-based recommendations for breast cancer screening for women at average risk of breast cancer. These recommendations should be considered by physicians and women in discussions about breast cancer screening.

Comment in

New Guidelines for Breast Cancer Screening in US Women. [JAMA. 2015]

PMID:: 26501536; [PubMed - indexed for MEDLINE]

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National Guideline Clearinghouse | Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society.

American Cancer Society

Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society.This updates a previously published guideline summary.

Guideline Title

Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society.

Bibliographic Source(s)

Oeffinger KC, Fontham ETH, Etzioni R, Herzig A, Michaelson JS, Shih YCT, Walter LC, Church TR, Flowers CR, LaMonte SJ, Wolf AMD, DeSantis C, Lortet-Tieulent J, Andrews K, Manassaram-Baptiste D, Saslow D, Smith RA, Brawley OW, Wender R, American Cancer Society. Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society. JAMA. 2015 Oct 20;314(15):1599-614. [122 references] PubMed External Web Site Policy

Guideline Status

This is the current release of the guideline.

This guideline updates a previous version:

Smith RA, Saslow D, Sawyer KA, Burke W, Costanza ME, Evans WP 3rd, Foster RS Jr, Hendrick E, Eyre HJ, Sener S. American Cancer Society guidelines for breast cancer screening: update 2003. CA Cancer J Clin. 2003 May-Jun;53(3):141-69. [184 references]

This guideline meets NGC's 2013 (revised) inclusion criteria.