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Comment & Response
April 2016

Progress Toward Consensus on Breast Cancer Screening Guidelines and Reducing Screening Harms—Reply

Author Affiliations
  • 1Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco
  • 2Department of Medicine, University of California-San Francisco, San Francisco
  • 3General Internal Medicine Section, Department of Veterans Affairs, University of California-San Francisco, San Francisco
JAMA Intern Med. 2016;176(4):562-563. doi:10.1001/jamainternmed.2016.0225

In Reply Updated American Cancer Society (ACS) breast cancer screening guidelines incorporate major changes that now align with the US Preventive Services Task Force (USPSTF) guidelines including: (1) no longer recommending screening clinical breast examination at any age; (2) biennial screening mammography for women starting in their 50s; and (3) no longer recommending regular screening mammography starting at age 40 years.1 Importantly, both guidelines acknowledge that women’s values and preferences have an important role in screening decisions where the balance of absolute benefits and harms is less certain. The USPSTF states,2 “The decision to start screening mammography in women prior to age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years.” The ACS states,1 “Women in their forties should have the choice to begin screening at age 40 or before age 45, based on their preferences and their consideration of the tradeoffs.” Thus, both guidelines acknowledge the uncertainty of starting screening at age 40 years and that consideration should be given for women’s values and preferences when deciding about mammography screening.

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