American Cancer Society Updates Mammography Guidelines for Average-Risk Women.

[Argirios Argiriou]

October 22, 2015

Andrew M. Kaunitz, MD

Recommendations move closer to those of the USPSTF — but differences remain.

Based on input from clinicians, public health specialists, laypeople, and a commissioned review, the American Cancer Society (ACS) has issued its first guideline update since 2003 regarding screening mammography for average-risk women (no personal history of breast cancer, known mutation associated with excess risk, or history of chest wall radiation at a young age). Recommendations are delineated as strong (consensus that the benefits of adhering to the recommendation outweigh undesirable effects) or qualified (clear evidence of benefits but less certainty about benefit–harm balance or women's preferences that could influence their decisions). The new guidelines are as follows:

    Age 40–44: Optional annual screening mammography (qualified)

    Age 45: Begin screening (strong)

    Age 45–54: Annual screening (qualified)

    Age ≥55: Biennial screening with option to continue annual screens (qualified)

    Continue screening as long as overall health is good and life expectancy is ≥10 years (qualified).

    Any age: Clinical breast examination (CBE) for screening is not recommended (qualified).

Comment

The updated ACS recommendations reduce the potential for harms (overdiagnosis and unnecessary additional imaging and biopsies) and move closer to the guidelines of the U.S. Preventive Services Task Force (USPSTF; i.e., begin biennial screening at age 50; NEJM JW Womens Heath Dec 2009 and Ann Intern Med 2009; 151:716).

As one editorialist points out, the ACS recommendation to begin screening at age 45 is based on observational comparisons between screened and unscreened cohorts, a type of analysis the USPSTF does not consider because of concerns about bias. The ACS's recommendation for annual screening in women aged 45–54 is based in part on the findings of a recent study showing that, for premenopausal (but not postmenopausal) women, tumor stage was higher and size larger for screen-detected lesions among women undergoing biennial screens.

The ACS recommendation against screening CBE, stemming from the absence of data supporting CBE's benefits (alone or with screening mammography), represents a dramatic change from the society's prior stance. Moreover, in leaving their 2003 guidance regarding breast self-examination unchanged, the ACS continues to recommend against this latter practice.

Overall, these updated guidelines should result in more women starting screening mammograms later in life as well as opting for biennial screening, meaning fewer lifetime screens. Also, fewer breast examinations during well-woman visits will allow clinicians more time to assess family history and other risk factors for breast cancer, as well as to maintain dialog about screening recommendations. In my practice, I will continue to encourage screening per USPSTF guidance (begin biennial screens at age 50) for my average-risk patients, while recognizing that many will be more comfortable starting screening at an earlier age and annually thereafter.

Editor Disclosures at Time of Publication

    Disclosures for Andrew M. Kaunitz, MD at time of publication Consultant / Advisory board Actavis plc; Bayer AG; Merck Royalties UpToDate Grant / Research support Therapeutics MD; Bayer; Agile; NIH Editorial boards Contraception; Menopause; Contraceptive Technology Update; OBG Management; Medscape OB/GYN & Women’s Health Leadership positions in professional societies
North American Menopause Society (Treasurer)

Citation(s):

    Oeffinger KC et al. Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society. JAMA 2015 Oct 20; 314:1599. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

    CrossRef
    Keating NL and Pace LE. New guidelines for breast cancer screening in US women. JAMA 2015 Oct 20; 314:1569. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

    Myers ER et al. Benefits and harms of breast cancer screening: A systematic review. JAMA 2015 Oct 20; 314:1615. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

    Miglioretti DL et al. Breast tumor prognostic characteristics and biennial vs annual mammography, age, and menopausal status. JAMA Oncol 2015 Oct 20; [e-pub]. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

    Chen WY.Measuring the effectiveness of mammography. JAMA Oncol 2015 Oct 20; [e-pub]. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

    Kerlikowske K.Progress toward consensus on breast cancer screening guidelines and reducing screening harms. JAMA Intern Med 2015 Oct 20; [e-pub]. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

- See more at: Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος

[Argirios Argiriou]

21/10/2015

Αμερικανική Αντικαρκινική Εταιρεία: Πότε πρέπει να κάνει η γυναίκα την πρώτη μαστογραφία.

Πηγή: Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος

[Argirios Argiriou]

Οι νέες οδηγίες της Αμερικανικής Αντικαρκινικής Εταιρείας για την πρόληψη στον καρκίνο του μαστού και οι δικές μας συστάσεις.

Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος

[Argirios Argiriou]

Αντιγράφω περίληψη που έκανε στα Ελληνικά ο συνάδελφος Vangelis Fousteris σε Ιατρική ομάδα του facebook στις 10/04/2019. Την παραθέτω μετά από άδειά του :

Βασικά σημεία

Για γυναίκες ηλικίας 40 έως 49 ετών, οι κλινικοί ιατροί θα πρέπει να επανεξετάσουν τα πλεονεκτήματα και τα μειονεκτήματα της μαστογραφίας πριν από την ηλικία των 50 ετών, λαμβάνοντας υπόψη τις προτιμήσεις των ασθενών. Η βλάβη του προσυμπτωματικού ελέγχου υπερβαίνει τα οφέλη για τις περισσότερες γυναίκες αυτής της ηλικιακής ομάδας.

Οι κλινικοί γιατροί θα πρέπει να υποβάλουν ανα 2ετια σε μαστογραφία ολες τις γυναίκες ηλικίας 50 έως 74 ετών.

Οι κλινικοί γιατροί θα πρέπει να διακόψουν τη διαλογή σε γυναίκες ηλικίας ≥75 ετών ή σε γυναίκες με προσδόκιμο ζωής ≤10 ετών.

Ανεξάρτητα από την ηλικία μιας γυναίκας, το CBE (clinical breast examination) δεν είναι μια χρήσιμη προσέγγιση για τον έλεγχο.

April 8, 2019

New ACP Guidance Statement: Breast Cancer Screening in Average-Risk Women

Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος