Amir Qaseem, MD, PhD, MHA; Jennifer S. Lin, MD, MCR; Reem A. Mustafa, MD, MPH, PhD; Carrie A. Horwitch, MD, MPH; Timothy J. Wilt, MD, MPH; for the Clinical Guidelines Committee of the American College of Physicians *
Note: Guidance statements are “guides” only and may not apply to all patients and all clinical situations. Thus, they are not intended to override clinicians' judgment. All ACP guidance statements are considered automatically withdrawn or invalid 5 years after publication, or once an update has been issued.
Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations.
Acknowledgment: The Clinical Guidelines Committee thanks members of the ACP Guidelines Public Panel for their review and comments on the paper from a nonclinician, public perspective: Cynthia Appley, Larry Curley, Jane Eleey, Ray Haeme, James Pantelas, Missy Carson Smith, and Lelis Vernon.
Financial Support: Financial support for the development of this guidance statement comes exclusively from the ACP operating budget.
Disclosures: Authors have disclosed no conflicts of interest. Authors followed the policy regarding conflicts of interest described at www.annals.org/article.aspx?articleid=745942. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-2147. All financial and intellectual disclosures of interest were declared, and potential conflicts were discussed and managed. Dr. Humphrey was recused from voting because of a moderate-level conflict (recipient of a university-funded grant and author of several recent publications related to the topic); Dr. Manaker was recused from discussion and voting because of a high-level conflict (household member owns stock in industry). A record of disclosures of interest and management of conflicts of interest is kept for each Clinical Guidelines Committee meeting and conference call and can be viewed at www.acponline.org/clinical_information/guidelines/guidelines/conflicts_cgc.htm.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Corresponding Author: Amir Qaseem, MD, PhD, MHA, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, email@example.com.
Current Author Addresses: Dr. Qaseem: 190 N. Independence Mall West, Philadelphia, PA 19106.
Dr. Lin: 3800 North Interstate Avenue, Portland, OR 97227.
Dr. Mustafa: 3901 Rainbow Boulevard, MS3002, Kansas City, KS 66160.
Dr. Horwitch: 1100 Ninth Avenue, C8-GIM, Seattle, WA 98101.
Dr. Wilt: VA Medical Center 111-0, Minneapolis, MN 55417.
Author Contributions: Conception and design: A. Qaseem, R.A. Mustafa, T.J. Wilt.
Analysis and interpretation of the data: A. Qaseem, J.S. Lin, R.A. Mustafa, T.J. Wilt.
Drafting of the article: A. Qaseem, R.A. Mustafa, C.A. Horwitch, T.J. Wilt.
Critical revision of the article for important intellectual content: A. Qaseem, J.S. Lin, R.A. Mustafa, T.J. Wilt.
Final approval of the article: A. Qaseem, J.S. Lin, R.A. Mustafa, C.A. Horwitch, T.J. Wilt.
Statistical expertise: A. Qaseem, T.J. Wilt.
Administrative, technical, or logistic support: A. Qaseem, T.J. Wilt.
Collection and assembly of data: A. Qaseem, T.J. Wilt.
The purpose of this guidance statement is to provide advice to clinicians on breast cancer screening in average-risk women based on a review of existing guidelines and the evidence they include.
This guidance statement is derived from an appraisal of selected guidelines from around the world that address breast cancer screening, as well as their included evidence. All national guidelines published in English between 1 January 2013 and 15 November 2017 in the National Guideline Clearinghouse or Guidelines International Network library were included. In addition, the authors selected other guidelines commonly used in clinical practice. Web sites associated with all selected guidelines were checked for updates on 10 December 2018. The AGREE II (Appraisal of Guidelines for Research and Evaluation II) instrument was used to evaluate the quality of guidelines.
The target audience is all clinicians, and the target patient population is all asymptomatic women with average risk for breast cancer.
In average-risk women aged 40 to 49 years, clinicians should discuss whether to screen for breast cancer with mammography before age 50 years. Discussion should include the potential benefits and harms and a woman's preferences. The potential harms outweigh the benefits in most women aged 40 to 49 years.
In average-risk women aged 50 to 74 years, clinicians should offer screening for breast cancer with biennial mammography.
In average-risk women aged 75 years or older or in women with a life expectancy of 10 years or less, clinicians should discontinue screening for breast cancer.
In average-risk women of all ages, clinicians should not use clinical breast examination to screen for breast cancer.
Qaseem A, Lin JS, Mustafa RA, Horwitch CA, Wilt TJ, for the Clinical Guidelines Committee of the American College of Physicians. Screening for Breast Cancer in Average-Risk Women: A Guidance Statement From the American College of Physicians. Ann Intern Med. [Epub ahead of print 9 April 2019]170:547–560. doi: 10.7326/M18-2147
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Published: Ann Intern Med. 2019;170(8):547-560.
Published at www.annals.org on 9 April 2019
Breast Cancer, Cancer Screening/Prevention, Guidelines, Hematology/Oncology, Prevention/Screening.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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