Medical Experts Debate New Breast Cancer Screening Guidelines

Most women gear up for their first annual mammogram at age 40 to screen for breast cancer, but new guidelines are challenging this long-established protocol. The American College of Physicians (ACP) has released updated guidance suggesting less frequent screenings starting at a later age for average-risk women.

Published in the Annals of Internal Medicine, the ACP’s new recommendations advise that average-risk, asymptomatic women between 50 and 74 years old should undergo mammograms every two years rather than annually. For women between 40 and 49, the guidance suggests discussing individual breast cancer risk with a doctor to weigh potential benefits against possible harms.

The ACP emphasized potential downsides of unnecessary screening, including false positive results, psychological distress, over-diagnosis, over-treatment, additional testing, and radiation exposure – concerns that have prompted the organization to take a more measured approach to mammography schedules.

For women 75 and older who are asymptomatic and at average risk, as well as those with limited life expectancy, the guidelines suggest discussing the possibility of discontinuing screening altogether, noting that “the benefits of screening beyond age 74 are reduced or uncertain, while potential harms, such as over-diagnosis, become more likely with increasing age.”

The ACP’s Clinical Guidelines Committee defined “average-risk” as women without a personal breast cancer history, high-risk breast lesion diagnosis, BRCA 1 or 2 genetic mutations, other familial breast cancer risk syndromes, or history of high-dose radiation therapy to the chest at a young age.

Dr. Jason M. Goldman, president of ACP, stated that screening for breast cancer is “essential and should be guided by the best available evidence.” He explained that the guidance aims to provide physicians and women with information needed to make informed breast cancer screening decisions.

For patients with dense breasts, the ACP encourages physicians to consider supplemental digital breast tomosynthesis (DBT), commonly known as 3D mammography. However, the organization specifically advises against using supplemental MRI or ultrasound for screening in this population.

This recommendation has drawn criticism from medical specialists in the oncology field. Lauren Carcas, a medical oncologist with the Miami Cancer Institute, part of Baptist Health South Florida, told Fox News Digital that these new guidelines “add to the confusion of screening recommendations.”

“Generally, this recommendation is based on a risk-based screening approach to determine who needs more frequent and/or aggressive screening versus who could safely space out screening frequency,” Carcas explained. “Doing so implies that all women have equal access to individualized discussions and nuanced risk-assessment through either their primary care or gynecologic physicians.”

Carcas warned that biennial screening recommendations could “potentially widen disparities and increase the likelihood of missing cancer in the populations that are already impacted by barriers to care.”

The ACP’s stance diverges significantly from other medical organizations. The American Society of Breast Surgeons and the American College of Radiology/Society of Breast Imaging continue to recommend annual mammography screenings beginning at age 40. This screening interval, according to Carcas, “remains the most consequential disagreement between all of the medical societies and the screening task force.”

Carcas also challenged the ACP’s recommendation against supplemental MRI and ultrasounds for women with dense breast tissue, noting, “The radiologic societies very strongly recommend the addition and consideration of breast ultrasound and/or MRI for more complete and accurate imaging.”

For high-risk women – those with a 20% or higher lifetime risk of developing breast cancer – Carcas recommends annual screening with supplemental ultrasound and MRI consideration. “For the average-risk woman, the conversation will be more nuanced between the patient and her physician,” she added.

Carcas pointed to a significant “gap in evidence” regarding mortality risk between annual and biennial screening, as no randomized controlled trial has yet investigated the difference between these approaches. “Most women who are diagnosed with breast cancer would certainly be grateful to have it diagnosed at an earlier stage, when there is less likely need for chemotherapy and other aggressive modalities of treatment,” she noted.

Despite the new ACP guidelines, Carcas plans to continue recommending annual screenings to her patients and offering ultrasounds and MRIs when needed. She expressed hope that the new recommendations “will not alter insurance coverage for patients undergoing screening, particularly in light of the differing recommendations among medical societies.”