Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society.
OBJECTIVE
Breast cancer is a leading cause of premature mortality among US women. Early detection has been shown to be associated with reduced breast cancer morbidity and mortality.


OBJECTIVE
To update the American Cancer Society (ACS) 2003 breast cancer screening guideline for women at average risk for breast cancer.


METHODS
The ACS commissioned a systematic evidence review of the breast cancer screening literature to inform the update and a supplemental analysis of mammography registry data to address questions related to the screening interval. Formulation of recommendations was based on the quality of the evidence and judgment (incorporating values and preferences) about the balance of benefits and harms.


RESULTS
Screening mammography in women aged 40 to 69 years is associated with a reduction in breast cancer deaths across a range of study designs, and inferential evidence supports breast cancer screening for women 70 years and older who are in good health. Estimates of the cumulative lifetime risk of false-positive examination results are greater if screening begins at younger ages because of the greater number of mammograms, as well as the higher recall rate in younger women. The quality of the evidence for overdiagnosis is not sufficient to estimate a lifetime risk with confidence. Analysis examining the screening interval demonstrates more favorable tumor characteristics when premenopausal women are screened annually vs biennially. Evidence does not support routine clinical breast examination as a screening method for women at average risk.


CONCLUSIONS
The ACS recommends that women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 years (strong recommendation). Women aged 45 to 54 years should be screened annually (qualified recommendation). Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation). Women should have the opportunity to begin annual screening between the ages of 40 and 44 years (qualified recommendation). Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer (qualified recommendation). The ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age (qualified recommendation).


CONCLUSIONS
These updated ACS guidelines provide evidence-based recommendations for breast cancer screening for women at average risk of breast cancer. These recommendations should be considered by physicians and women in discussions about breast cancer screening.
Memorial Sloan Kettering Cancer Center, New York, New York.
Kevin C
KC
Oeffinger
Louisiana State University School of Public Health, New Orleans.
Elizabeth T H
ET
Fontham
University of Washington and the Fred Hutchinson Cancer Research Center, Seattle.
Ruth
R
Etzioni
Patient advocate, Troy, New York.
Abbe
A
Herzig
Massachusetts General Hospital and Harvard Medical School, Boston.
James S
JS
Michaelson
University of Texas MD Anderson Cancer Center, Houston.
Ya-Chen Tina
YC
Shih
University of California, San Francisco, and San Francisco VA Medical Center.
Louise C
LC
Walter
Masonic Cancer Center and the University of Minnesota, Minneapolis.
Timothy R
TR
Church
Emory University School of Medicine and Winship Cancer Institute, Atlanta, Georgia.
Christopher R
CR
Flowers
Independent retired physician and patient advocate.
Samuel J
SJ
LaMonte
University of Virginia School of Medicine, Charlottesville.
Andrew M D
AM
Wolf
American Cancer Society, Atlanta, Georgia.
Carol
C
DeSantis
American Cancer Society, Atlanta, Georgia.
Joannie
J
Lortet-Tieulent
American Cancer Society, Atlanta, Georgia.
Kimberly
K
Andrews
American Cancer Society, Atlanta, Georgia.
Deana
D
Manassaram-Baptiste
American Cancer Society, Atlanta, Georgia.
Debbie
D
Saslow
American Cancer Society, Atlanta, Georgia.
Robert A
RA
Smith
American Cancer Society, Atlanta, Georgia.
Otis W
OW
Brawley
American Cancer Society, Atlanta, Georgia.
Richard
R
Wender
D000328:Adult; D000367:Age Factors; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality; D055088:Early Detection of Cancer; D019317:Evidence-Based Medicine; D005260:Female; D006304:Health Status; D006801:Humans; D008017:Life Expectancy; D008327:Mammography / Q000592:standards*; D008875:Middle Aged; D012196:Review Literature as Topic; D012306:Risk; D014463:Ultrasonography