ACOG Guidance: Individualize Breast
Cancer Screening
Marcia Frellick
June 23, 2017
New breast cancer screening guidance
from the American College of Obstetricians and Gynecologists (ACOG) highlights
the importance of shared decision-making between the patient and provider.
The practice bulletin, published in the July issue of Obstetrics &
Gynecology, focuses on women at average risk for breast cancer. The authors
acknowledge the existing confusion from disagreement among major guidelines on
when to start screening mammograms and how often to have them.
"Our new guidance considers
each individual patient and her values," Given the range of current
recommendations, we have moved toward encouraging obstetrician–gynecologists to
help their patients make personal screening choices from a range of reasonable
options."
The decisions of when to start and
end screening and how often to have it should follow discussions of the woman's
health history and her concerns and preferences surrounding the potential harms
and benefits of the screening.
The practice bulletin, which was
developed by the Committee on Practice Bulletins–Gynecology in collaboration
with Mark Pearlman, MD; Myrlene Jeudy, MD; and David Chelmow, MD, also says
that women at average risk for breast cancer should be offered screening
mammograms starting at 40 years of age and should start no later than age 50
years.
This differs from some other major
guidelines. The US Preventive Services Task Force, for instance, recommends
mammograms start at age 50 years. At ages 40 to 49 years, the decision should
be made individually, the task force says. The American Cancer Society says
screening should be offered at 40 years, but recommends starting at age 45
years.
Regarding frequency, average-risk
women should have screening mammograms every 1 to 2 years and should continue
to have them until age 75 years, ACOG says. After that, the choice to continue
should be based on shared decision-making that takes into account women's
health status and expected lifespan.
Among the B-level recommendations,
based on limited or inconsistent scientific evidence, the updated guidelines
say providers should assess breast cancer risk periodically by reviewing the
patient's history.
"Initial assessment should
elicit information about reproductive risk factors, results of prior biopsies,
ionizing radiation exposure, and family history of cancer," they write.
In addition, breast self-exams are
not recommended in average-risk women because of the risk for harm from
false-positive results and lack of evidence it benefits patients.
Instead, average-risk women should
be counseled about breast self-awareness, or the normal look and feel of her
breasts. So rather than routinely examining their own breasts, the women should
be educated on noticing pain, a mass, new nipple discharge, or redness, and
then telling their physicians if these signs occur.
The bulletin did not address
recommendations for women at high risk for breast cancer or use of new
technologies such as tomosynthesis. It also did not offer advice for women with
dense breasts, who have a modestly increased risk for breast cancer.
.
Cite
this article: ACOG Guidance: Individualize Breast Cancer
Screening - Medscape - Jun 23, 2017.
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