The American College of Physicians (ACP) suggests "average-risk women" wait until age 50 to start getting screened for breast cancer.

By Renee Cherry
April 09, 2019
Photo: BSIP/Getty Images

This week, the American College of Physicians (ACP) announced new mammogram guidelines for how often doctors should recommend breast-cancer screening to their patients. Women who are at "average risk" should be advised to book a mammogram every other year, starting at age 50 until they're 74 years old, according to the new recommendations.

To arrive at these new mammogram recommendations, the ACP analyzed all existing guidelines in the U.S. from 2013 through 2017, as well as guidelines from Canada and the World Health Organization (WHO). Given that American women have a one in eight chance of developing breast cancer, it might seem like an odd move to suggest a relatively conservative approach to getting screened. But since age is "the single most important risk factor," at a certain point, the potential consequences of getting yearly mammograms can significantly outweigh the benefits, according to the ACP. Those potential consequences can include overdiagnosis, which can lead women with false-positive results to opt for an unnecessary biopsy, as well as increased lifetime radiation exposure. (Related: This Woman Got a Preventive Double Mastectomy and Later Learned the DNA Testing Was Wrong)

In addition to recommending biannual mammograms for average-risk women aged 50-74, the ACP came up with three more new guidelines:

  1. Women aged 40-49 who have an average risk of breast cancer should talk to their doctor about the pros and cons of getting mammograms before age 50. For most women with an average risk, the cons will outweigh the pros, according to the ACP.
  2. Average-risk women over 75 or who have a life expectancy under 10 years shouldn't get screened for breast cancer.
  3. Doctors should use mammograms rather than clinical breast examination (CBE) to screen for breast cancer.

Note, the new recs specifically apply to women who have an average risk of developing breast cancer, meaning the guidelines don't apply to women who have previously had abnormal screening results, breast cancer in their family, a genetic mutation linked to increased cancer risk, etc. But some women who are considered to be at a higher risk under other guidelines-such as those who experience late-onset menopause or women who have dense breasts-don't fall under the ACP's definition of increased risk. Rather, all four of these new guidelines would apply to them. (Related: This Viral Photo of Lemons Is Helping Women Detect Breast Cancer)

To say the least, there are clearly some discrepancies among these different guidelines, and the ACP's new mammogram recommendations are already proving to be controversial, as the medical community at large isn't unanimous on how often women should be getting screened. For example, the American College of Radiology (ACR) released a statement arguing why the ACP's new guidelines "would result in thousands of unnecessary breast cancer deaths." The ACR's statement also pointed out that the American Cancer Society and the Society of Breast Imaging call for average-risk women to begin getting mammograms at age 40.

"What's frustrating for us is these guidelines further muddy the waters and likely will have an effect on patients not getting screened when they should be," Sarah Friedewald, M.D., chief of breast imaging at Northwestern Medicine, told NBC Chicago.

So, yeah, this probably won't be the last you hear about best mammo practices. For now, no matter who you are or what your risk factors are, the best thing you can do is to have an open discussion with your doctor about any questions or concerns you may have.