Breast Cancer Screening - ACP

Screening for Breast Cancer in Average Risk Women: A Guidance Statement from the American College of Physicians. (2019).

 Take Aways: 
ONLY FOR AVERAGE RISK WOMEN
- 40-49 yo: discuss risk/benefits with physician for mammography - usually risk > benefits here
- 50-74 yo: biennial mammography
- 75+ OR life expectancy 10 yrs or less: discontinue breast cancer screening
- clinical breast examinations are not helpful to screen for breast cancer

----

 Intro
- breast cancer for common cancer type in women, 4th leading cancer death in US
- age is most important risk factor for breast cancer
- average risk women exclude:
> hx of breast cancer
> genetic mutations (BRCA1/2)
> exposure to radiation tx to chest
> Does NOT exclude: early menarche, late menopause, OCP tx, increased breast density, family history


 Methods
- examined guidelines from multiple sources and determined their guideline qualities (WHO, ACS, USPSTF, CTFPHC, ACOG, ACR, NCCN)
- many guidelines ignored the absolute effect on breast cancer mortality and the long lead time to any reduction in mortality, and low incidence of breast cancer in <60 yo women


Mammography 
- harms mostly include overdiagnosis and overtreatment
> mostly in 40-49 yo
> worse if annual vs biennial
- 3.7 mGy per digital mammography

 Clinical Breast Examination
- no direct clinical benefits of CBE alone and causes fale positive results

 Other Imaging
- strong recommendation AGAINST using MRI or US or DBT for first line screening in average risk women for breast cancer

 Of Note
- basically ACP says it sucks to have dense breasts, but there's no change in recommendation for it


 Extra Data
USPSTF (5) showed:   
- Ages 40–49 y: May be 3 fewer deaths per 10 000 women screened over 10 y   
- Ages 50–59 y: 8 fewer breast cancer deaths per 10 000 women screened over 10 y 
- Ages 60–69 y: 21 fewer breast cancer deaths per 10 000 women screened over 10 y 
- Ages 70–74 y: May be 13 fewer deaths per 10 000 women screened over 10 y

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