- 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
- The ACP's guidance has already been attacked by the American College of Radiology and the Society of Breast Imaging as resulting in up to 10,000 additional, and unnecessary, breast cancer deaths.
- 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.
- 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.
- Did not perform literature review.