May 16, 2003 — The new American Cancer Society Guidelines for Breast Cancer Screening, published in the society"s May-June issue of CA: A Cancer Journal for Clinicians, provide new recommendations for self- and clinical breast examinations at earlier ages, mammography for older and higher-risk women, as well as for new technologies.

During the last decade, breast cancer screening gained wide acceptance by women and physicians, data supporting the efficacy of screening mammography have undergone intensive re-examination, and the benefits of regular mammography have been affirmed, write Robert A. Smith, PhD, director of cancer screen at the American Cancer Society in Atlanta, Georgia, and a member of the High-Risk Work Group, and colleagues. Now, breast cancer screening is at yet another critical juncture due to multiple factors that may be eroding access, including declining interest in performing the procedure by radiologists, low reimbursement, and high malpractice exposure.

The new guidelines address screening mammography, physical examination, and new screening technologies, applied to older women, those with comorbid conditions, and those at high risk.

For women at average risk, mammography should begin at age 40 years. Women in their 20s and 30s should have clinical breast examination as part of a routine physical, at least every three years. At 40 years of age and thereafter, clinical breast examination should be done annually.

The benefits, limitations, and implications of breast self-examination (BSE) should be explained to women in their 20s and older. Those opting to perform regular BSE should have their technique reviewed during their periodic health examination.

In older women, screening should be individualized based on potential benefits and risks of mammography in light of current health and life expectancy. As long as a woman is in reasonably good health and would be a candidate for treatment, she should continue to be screened with mammography, the authors write.

Considerations for high-risk women include earlier initiation of screening, more frequent screening, or the addition of ultrasound, magnetic resonance imaging, or other modalities. However, the evidence currently available is insufficient to justify recommendations for any of these screening procedures, the authors write.

Mandates for future research include distinguishing aggressive nonaggressive cancers, identifying better screening methods for women at high-risk, evaluating the effect of hormone replacement therapy on breast density and on screening interpretation, clarifying the role of the physical examination, and improving the efficacy of screening mammography.

Each of the screening methods that was considered has limitations, and there are potential harms associated with false-positive findings, the authors write. Thus, women should be informed both about the benefits and limitations of screening and the possibility of harms associated with false-positive findings.