ACP Guideline for Mammography encourages individual decision for women 40 to 49 years
Qaseem et al, 2007, Ann Intern Med., 146: 511-515, 516-526, 529-532
The American College of Physicians (ACP) recommends tailoring the decision about screening for breast cancer in women aged 40-49 years based on the woman’s concerns about mammography and breast cancer, and her risk of breast cancer because of the associated benefits and risks for this age group.
Available evidence suggests that breast cancer risk, and therefore the benefit of screening mammography, is not evenly distributed in women between the ages of 40 and 49 years.
The ACP panel developed evidence-based guidelines after reviewing 117 studies concerning the risks and benefits of mammography screening for women in this age group.
Despite good evidence that mammography reduces mortality for breast cancer in 50-70 year old women, mandating routine screening for women in this age group, evidence for younger women is conflicting.
A 2002 meta-analysis by the US Preventive Services Task Force reviewed data from many clinical trials and estimated that screening mammography every 1-2 years in women aged 40 to 49 was associated with a 15% decrease in breast cancer mortality after 14 years of follow-up. However, a separate Canadian study showed no benefit from mammography for women in this age group.
The ACP expert panel provided 4 main recommendations concerning screening mammography for women between the ages of 40 and 49 years:
- to help guide decisions about screening mammography, clinicians should periodically perform individualized assessments of risk for breast cancer
- clinicians should inform these women about the potential benefits and harms of screening mammography
- clinicians should make their decisions concerning screening mammography on a case-by-case basis, considering not only the benefits and harms of screening, but also the woman’s individual preferences and her specific breast cancer risk profile.
- further research should be done on the net benefits and harms of breast cancer screening modalities for women in this age group.
The ACP’s guidelines
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the decision of whether to perform screening mammography among women 40 to 49 years of age should be individualized for each patient. The 5-year risk of developing breast cancer at these ages can range from 0.4% to 6%. Women in this age range who have the following risk factors carry a higher risk for breast cancer vs women who are 50 years of age:
- 2 first degree relatives with breast cancer
- 2 previous breast biopsies
- 1 first degree relative with breast cancer + 1 previous breast biopsy
- previous diagnosis of breast cancer, atypical hyperplasia, or ductal carcinoma-in-situ
- previous chest irradiation
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BRCA1 or BRCA2 mutation
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the risk assessment for breast cancer for each patient should be re-evaluated every 1-2 years. Risk assessment tools, such as the Gail model, are limited in aiding clinicians and patients to make individualized decisions.
Berita Menopos - June 2007