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June 26, 2013

Breast Cancer Screening: Conflicting Guidelines and Medicolegal Risk

Author Affiliations

Author Affiliations: Department of Medicine, Brigham and Women's Hospital, Harvard Medical School (Dr Kachalia); and Department of Health Policy and Management, Harvard School of Public Health (Dr Mello), Boston, Massachusetts.

JAMA. 2013;309(24):2555-2556. doi:10.1001/jama.2013.7100

There is considerable inconsistency and controversy in today's guidelines regarding breast cancer screening. Although the presence of a wide range of professionally endorsed options arguably gives physicians a broader set of clinically valid choices, these options may paradoxically leave clinicians feeling more exposed to claims of malpractice.

Consider the decision about how to best manage a healthy, 52-year-old woman who has no risk factors for breast cancer and presents for routine screening. Guidelines issued by 4 highly respected organizations provide conflicting recommendations about the appropriate interval for screening mammography of women aged 40 to 74 years at average risk of breast cancer, and whether clinical breast examination (CBE) should be performed.1-4 The 2008 American College of Radiology and 2003 American Cancer Society guidelines recommend annual screening mammography for asymptomatic, average risk women aged 40 years and older.1,4 The American Cancer Society also recommends periodic CBE, “preferably annually.” In contrast, 2009 US Preventive Services Task Force (USPSTF) guidelines recommend biennial mammography for women aged 50 to 74 years and deem existing evidence insufficient to support a conclusion about the benefit of CBE.2 The 2011 American College of Obstetricians and Gynecologists guidelines state that CBE should be performed annually and that although mammography should be offered annually, biennial mammography may be “more appropriate or acceptable” for some women.3