New NCCN Guidelines for Mammography: All Women Over 40 New NCCN Guidelines for Mammography: All Women Over 40

New evidence-based patient-facing breast cancer guidelines from the National Comprehensive Cancer Network (NCCN) call for annual mammograms for all average-risk women over age 40 years.

This simplifies the message, says the NCCN.

“There are many, often conflicting, recommendations surrounding breast cancer screening, which causes a lot of confusion and apprehension,” commented Therese Bevers, MD, professor of clinical cancer prevention at the University of Texas MD Anderson Cancer Center and chair of the guidelines panel

“These are the latest, evidence-based guidelines from experts in the field of breast cancer screening and diagnosis from more than two dozen leading cancer centers in the United States,” she said in a statement.

The NCCN guidelines, Breast Cancer Screening and Diagnosis, were published “to help people understand their personal risk for breast cancer, when they should begin screening, and how often to screen — in order to detect cancer earlier, for more treatment options and better outcomes,” the organization explained in its press release.

They are available for free at NCCN.org/patientguidelines and via the NCCN Patient Guides for Cancer App.

The new guidelines state that women should undergo a breast cancer risk assessment starting at age 25 years, and they emphasize annual mammography screening beginning at age 40 years for those with average risk — a screening approach that offers the greatest mortality reduction, according to available evidence.

An earlier start may be recommended for those with additional risk factors, Bevers noted. Screening is also important for those who are pregnant or breastfeeding.

“A lot of women think they need to put this on hold, but we can shield the belly, and the radiation is very low dose and targeted. It’s important to keep up with screenings. Especially for women whose first pregnancy is happening when they are 40 or older,” Bevers commented.

The guidelines also address evaluation of breast symptoms, such as a palpable lump, pain, or nipple discharge, and emphasize the need for prompt clinical and diagnostic evaluation, including imaging and biopsy, in some cases.

Different Screening Recommendations

Breast cancer screening guidelines differ across medical organizations. A chart developed by the Centers for Disease Control and Prevention highlights variations across guidelines published by the US Preventive Services Task Force (USPSTF), the American Cancer Society (ACS), the American College of Obstetricians and Gynecologists (AOG), the American College of Radiology (ACR), and others.

The USPSTF calls for an individualized approach to screening for women before age 50 years; the ACS says those aged 40-44 years should have the choice to start annual screening; the ACOG supports personal choice and shared decision-making after appropriate counseling, with mammography offered annually or biannually; and the ACR also calls for informed decision-making about annual mammography after age 40 years.

These guidelines also differ in their recommendations for women older than 50 and for women at high risk.

NCCN aims to help women sort out their options through the new plain-language guidelines and to equip them “to have more informed conversations with their health care providers and be active decision-makers in their long-term health.”

“These guidelines will help so many people,” said Sue Friedman, DVM, executive director of Facing Our Risk of Cancer Empowered (FORCE), an advocacy and support organization for people with hereditary cancers.

“There is general confusion about breast cancer screening guidelines and what screening people should follow based on their risk,” she added. “These NCCN patient guidelines are an easy way for people to access up-to-date expert recommendations in plain language.”

Sharon Worcester, MA, is an award-winning medical journalist based in Birmingham, Alabama, writing for Medscape, MDedge and other affiliate sites. She currently covers oncology, but she has also written on a variety of other medical specialties and healthcare topics. She can be reached at sworcester@mdedge.com or on Twitter: @SW_MedReporter

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