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The American College of Physicians (ACP) issued new guidance statements on breast cancer screening for asymptomatic women of average-risk. This issue follows a thorough review and inclusion of the following existing guidelines and associated evidence:


  1.  American College of Obstetricians and Gynecologists (ACOG) – 2017
  2. American College of Radiology (ACR) – 2017
  3. American Cancer Society (ACS) – 2015
  4. Canadian Task Force on Preventive Health Care (CTFPHC) – 2018
  5. National Comprehensive Cancer Network (NCCN) – 2018
  6. U.S. Preventive Services Task Force (USPSTF) – 2016
  7. World Health Organization (WHO) – 2014

Screening methods include clinical breast examination (CBE) and breast imaging (i.e. mammography, ultrasonography, magnetic resonance imaging [MRI], and digital breast tomosynthesis [DBT]). It does not cover breast self-examination.

Guidance Statement 1

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.

Guidance Statement 2

In average-risk women aged 50 to 74 years, clinicians should offer screening for breast cancer with biennial mammography.

Guidance Statement 3

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.

Guidance Statement 4

In average-risk women of all ages, clinicians should not use clinical breast examination to screen for breast cancer.


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