New European Breast Guidelines do not support mammograms for 40-45 year olds

  • Schünemann HJ & al.
  • Ann Intern Med
  • 26 Nov 2019

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • The European Breast Guidelines, coordinated by the European Commission's Joint Research Center, has issued 15 guidelines for breast cancer screening and diagnosis, including a recommendation against mammographic screening from ages 40 to 45 years for the average-risk woman.

Why this matters

  • The screening guidelines are in agreement with those from the American College of Obstetricians and Gynecologists, the American College of Physicians, and the American Cancer Society.

Study design

  • 28 multidisciplinary members, including patients, developed guidelines after review of the evidence and assignment of GRADE (Grading of Recommendations Assessment, Development, and Evaluation).
  • Funding: The European Commission.

Key recommendations

  • For the average-risk woman (without increased risk due to genetic predisposition [mutations in BRCA1 and BRCA2], reproductive history, or race/ethnicity), guidelines recommend:
    • Ages 40-45 years: no screening.
    • Ages 45-49 years: screening every 2-3 years.
    • Ages 50-69 years: screening every 2 years.
    • Ages 70-74 years: screening every 3 years.
    • Use digital mammography alone over screening with digital breast tomosynthesis (DBT; or 3D mammography).
  • For women with high breast density and negative mammography, do not implement tailored screening with automated breast ultrasonography, hand-held ultrasound, or MRI.
  • DBT should be used for diagnosis in average-risk women recalled because of suspicious lesions at digital mammography.

Limitations

  • Lack of high-certainty evidence for some recommendations.