ACOG 2017: Debate Continues Over Timing and Frequency of Breast Cancer Screening
Regarding the U.S. Preventive Services Task Force Guidelines for Breast Cancer Screening, not all physicians see eye to eye, as was evidenced during the John and Marney Mathers Lecture at the 2017 American College of Obstetricians and Gynecologists (ACOG) Annual Clinical and Scientific Meeting. The task force assigned a “C” grade to biannual screening for women between the ages of 40 and 49, suggesting a marginal benefit in the practice, and a “B” grade to biannual screening for women between the ages of 50 and 74, suggesting the recommendation’s net benefit was deemed to be moderate.
“Both of these are positive recommendations,” said George Sawaya, MD, of the University of California, San Francisco. “Women who place a higher value on their potential benefits than the potential harms may choose to begin biannual screening between the ages of 40 and 49.”
Mark Pearlman, MD, of the University of Michigan Hospital and Health Systems in Ann Arbor, offered a rationale for annual testing of women in their 40s based on sojourn time—the time period when cancer may be detected by screening before becoming symptomatic.
“Women who have breast cancers that are detected at younger ages tend to have biologically more aggressive tumors, and sojourn time doubles in women in their 40s compared to women in their 70s,” explained Dr. Pearlman. He suggested that physicians encourage younger women to have annual screenings and move to biannual screening as they get older.