American Cancer Society Now Recommends Delayed and Less Frequent Screening Mammograms

Initiate an active discussion with your clinician about screening at age 40 years if you have an average risk of developing breast cancer, but regular screening mammograms can wait till age 45 years. This is the new evidence-based guidance update provided by the American Cancer Society (ACS), published yesterday in JAMA Internal Medicine.

The leading cause of cancer death in women in the United States, second to lung cancer, nearly 240,000 women are expected to be diagnosed with the disease this year. Despite increased disease awareness and rapid strides in research and drug development, mortality among breast cancer patients remains high.

The previous ACS recommendations for breast cancer screening were published more than a decade ago and recommended that women at average risk should begin screening at age 40 years. A periodic, preferably annual, breast exam was recommended for women aged 40 years and over. Women at an increased risk of breast cancer, the guidelines recommended, should be offered an earlier screening, shorter screening intervals, and the inclusion of ultrasound or magnetic resonance imaging, along with a physical exam and a mammogram, to their screening modalities.

The updated guideline for women with an average risk of developing breast cancer (ie, women without a personal history of breast cancer, a suspected or confirmed genetic mutation that can increase risk, or a history of chest radiotherapy at a young age) are:

1a. Women aged 45 to 54 years should be screened annually. (Qualified Recommendation)

1b. Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually. (Qualified Recommendation)

1c. Women should have the opportunity to begin annual screening between the ages of 40 and 44 years. (Qualified Recommendation)

1. Women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 years. (Strong Recommendation)2. 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)

3. The ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age. (Qualified Recommendation)

The article emphasizes the need for a discussion of personal and family medical history with the individual’s physician and a periodic evaluation of whether the risk profile has altered. Additionally, the ACS recommends that women should be informed on the risk factors, risk reduction, benefits, and harms, associated with mammography screening.