News & Commentary

Many Women Don’t Need Annual Mammograms; Screens Every Other Year Will Suffice

Frank Diamond

For women who are at average risk of breast cancer and who don’t show symptoms, getting a mammogram every year after age 50 does not improve outcomes and might increase risks due to overdiagnosis, according to guidelines by the American College of Physicians.

The guidelines, published in the April 9 issue of the Annals of Internal Medicine, warn against screening too early or too often. Mammograms may catch small, slow-growing tumors that are not likely to become fatal. In addition, such screening won’t help catch advanced cancer cases any more than screening every other year would, according to the guidelines.

The result can be unnecessary invasive follow-up tests and treatments for tumors that would never have become threatening, let alone lethal. About 33 million mammograms are given in the United States each year.

Joann Elmore, MD, a professor at the David Geffen School of Medicine at the University of California–Los Angeles, wrote an editorial accompanying the guidelines. She told Reuters that screening every year increases the harms “markedly, with less of an increase in the benefits….”

ACP researchers looked at breast cancer screening guidelines from around the world published in English between Jan. 1, 2013 and Nov. 15, 2017. They also checked for updates on cancer guideline websites on Dec. 10, 2018.

“The target audience is all clinicians, and the target patient population is all asymptomatic women with average risk for breast cancer,” the guidelines state.

Here are the updated guidelines;

Guidance Statement 1: In average-risk women aged 40 to 49 years, clinicians should discuss whether to screen for breast cancer with mammography before age 50 years. Discussion should include the potential benefits and harms and a woman’s preferences. The potential harms outweigh the benefits in most women aged 40 to 49 years.

Guidance Statement 2: In average-risk women aged 50 to 74 years, clinicians should offer screening for breast cancer with biennial mammography.

Guidance Statement 3: In average-risk women aged 75 years or older or in women with a life expectancy of 10 years or less, clinicians should discontinue screening for breast cancer.

Guidance Statement 4: In average-risk women of all ages, clinicians should not use clinical breast examination to screen for breast cancer.

This far from settles the issue. As Reuters reports, the American Cancer Society still says women, ages 45 to 54, should get mammograms every year. At 55, women can choose between yearly or biennial mammograms.

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