Breast Cancer Screening for Women at Average Risk
- Study type
- Clinical guideline
- Study name
- ACS 2015
- Design
- Clinical guideline based on a systematic review of the evidence and a supplementary analysis of mammography registry data
- Source
- JAMA · 2015
In plain words
This guideline advises women at average risk of breast cancer to start regular screening with mammograms at age 45. Women aged 45 to 54 have a mammogram once a year, and from age 55 every two years (or still every year if they prefer). Women aged 40 to 44 can also start yearly screening if they wish. Screening should continue as long as a woman is in good general health and expected to live 10 years or more. It is best to make the final decision with your doctor after talking about the benefits and harms (such as false-positive results).
Key points
Key guideline recommendations
- Strong recommendation
Women at average risk of breast cancer should begin regular screening mammography at age 45.
- Qualified recommendation
Women aged 45 to 54 should be screened annually.
- Qualified recommendation
Women aged 55 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.
- 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 American Cancer Society does not recommend clinical breast examination for breast cancer screening among average-risk women at any age.
Study population
Women at average risk of breast cancer (the target population of the screening guideline).
Endpoints
This guideline is not a clinical trial and has no endpoints. The recommendations were developed on the basis of the quality of the evidence and a judgement (taking values and preferences into account) about the balance of benefits and harms. The topics examined include reduction in breast cancer mortality, false positives, overdiagnosis, screening interval and clinical breast examination.
Safety and side effects
The main harms of screening examined in the guideline are false-positive results (with a higher cumulative risk if screening starts at a younger age) and overdiagnosis, for which the quality of evidence is insufficient to estimate its lifetime risk with confidence.
Clinical significance and place in guidelines
This guideline sets the recommended age to start regular screening mammography in women at average risk at 45 (strong recommendation), with the option of annual screening from age 40 to 44, a transition to biennial screening from age 55, and continuation of screening based on overall health and a life expectancy of at least 10 years. It also does not recommend clinical breast examination for screening in women at average risk. These recommendations are designed for use in shared decision-making between doctor and patient. The current status of this guideline and newer guidelines from other bodies should be checked separately.
Limitations
According to the abstract, the quality of evidence on overdiagnosis is insufficient to estimate its lifetime risk with confidence, and support for screening in women aged 70 and older rests on inferential evidence. This guideline covers only women at average risk. An erratum has been published for this paper (JAMA 2016;315(13):1406) and should be reviewed together with the full text.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.