06:54pm Wednesday 26 February 2020

New Guidelines for Breast Cancer Screening in US Women

What: Editorial: “New Guidelines for Breast Cancer Screening in US Women”

Nancy L. Keating, MD, MPH; Lydia E. Pace, MD, MPH of the Division of General Internal Medicine & Primary Care at Brigham and Women’s Hospital.  Dr. Keating is also in the Department of Health Care Policy at Harvard Medical School.  Keating and Pace are available to discuss their editorial.  For more information, or to arrange an interview, please contact Elaine St. Peter, estpeter@partners.org

New breast cancer screening guidelines recommended by the American Cancer Society (ACS) are published in the October 20 issue of JAMA. These are the first breast cancer screening recommendations since 2003 when the ACS recommended annual mammography screening for all women starting at age 40 years. The new guidelines outline a more conservative starting age for mammography (45 vs. 40 years) compared with the prior ACS guideline, annual screening for women aged 45-54, biennial screening for women 55 and older, a recommendation against routine clinical breast examination, and the recommendation to stop screening among women with a life expectancy of less than ten years.

In an accompanying editorial, Keating and Pace comment that development of the ACS revised guidelines followed “a more transparent, consistent, and rigorous process” than previous ACS guidelines and strive to outline “screening strategies to optimize the balance between benefits and harms” of mammography, “most notably the possibility of over diagnosis and resultant overtreatment, and also the risk of false positives and unnecessary biopsies.”  

Keating and Pace note some limitations to the new guidelines including their reliance on observational studies, which are vulnerable to more bias than randomized controlled trials, as well as the lack of long-term outcomes data suggesting that annual versus biennial screening among younger women results in better breast cancer outcomes.  They also note that “the vast majority of women who are diagnosed with breast cancer will do well regardless of whether their cancer was found by mammography,” and that “about 85% of women in their 40s and 50s who die of breast cancer would have died regardless of mammography screening.”

Keating and Pace underscore the importance of individualized shared decisions with patients to identify the screening strategy that is best for them.  They conclude that with a “more personalized understanding of breast cancer risk,” it would be possible to “identify those women who are most likely to benefit from earlier and more frequent breast cancer screening and less likely to experience the related harms. 

Keating and Pace have previously done research looking at the risk of mammography false positives resulting in unnecessary biopsies, and have been proponents of screening strategies to optimize the balance between benefits and harms of mammography.

Contact: Elaine St. Peter,

617-525-6375 (o); estpeter@partners.org

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