Physician groups diverge on breast cancer screening guidelines

  • Qaseem A & al.
  • Ann Intern Med
  • 10 Apr 2019

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

  • The American College of Physicians (ACP) issued breast cancer screening guidance for the average-risk woman.
  • They call for less overall screening, especially in women aged 40-49 years and ≥75 years.

Why this matters

Study design

  • An ACP panel reviewed all the other guidelines and the evidence for those guidelines.
  • AGREE II (Appraisal of Guidelines for Research and Evaluation II) was used to guideline quality.
  • A guidance is for topics in which several conflicting guidelines are available.

Key results

  • Guidance is intended for average-risk woman (including women with dense breasts and excluding personal history of breast cancer, previous high-risk lesion, or BRCA mutation carrier).
  • The 4 recommendations are:
    • Women aged 40-49 years: discuss mammography's benefits and risks and point out that potential harms outweigh the benefits (e.g., a 19.7%-42% rate of false-positive results over 10 years).
    • Aged 50-74 years: offer biennial mammography.
    • Aged ≥75 years, or when life expectancy is ≤10 years: discontinue screening.
    • Across all ages: refrain from using clinical breast exams as screening tools.

Limitations

  • Did not perform literature review.

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