Clinical Edge

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Breast Cancer Risk Assessment & Screening

Obstet Gynecol; ePub 2017 Jul; Pearlman, et al

Women at average risk of breast cancer should be offered screening mammography starting at age 40 years, according to clinical management guidelines issued by the American College of Obstetricians and Gynecologists (ACOG). The practice bulletin discusses breast cancer risk assessment, reviews breast cancer screening guidelines in average-risk women, and outlines some of the controversies surrounding breast cancer screening. Among the recommendations offered:

Level A recommendations:

  • Women at average risk of breast cancer should be offered screening mammography starting at age 40 years. Women at average risk of breast cancer should initiate screening mammography no earlier than age 40 years. If they have not initiated screening in their 40s, they should begin screening mammography by no later than age 50 years. The decision about the age to begin mammography screening should be made through a shared decision-making process. This discussion should include information about the potential benefits and harms.
  • Women at average risk of breast cancer should have screening mammography every 1 or 2 years based on an informed, shared decision-making process that includes a discussion of the benefits and harms of annual and biennial screening and incorporates patient values and preferences. Biennial screening mammography, particularly after age 55 years, is a reasonable option to reduce the frequency of harms, as long as patient counseling includes a discussion that with decreased screening comes some reduction in benefits.
  • Women at average risk of breast cancer should continue screening mammography until at least age 75 years.

Level B recommendations:

  • Health care providers periodically should assess breast cancer risk by reviewing the patient’s history.
  • Women with a potentially increased risk of breast cancer based on initial history should have further risk assessment.
  • Breast self-examination is not recommended in average-risk women because there is a risk of harm from false-positive test results and a lack of evidence of benefit.

Citation:

Breast cancer risk assessment and screening in average-risk women. Practice Bulletin No. 179. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2017;130:e1–16.