According to the American College of Physicians, how often should women at average risk be screened for breast cancer?

Citing that the harms of screening (false-positive results, benign biopsies, and overdiagnosis) outweigh the benefits of early diagnosis, the American College of Physicians (ACP) does not recommend routine screening of women between the ages of 40 years and 49 years; instead, the group suggests a discussion based on an overview of benefits and harms. Women aged 50 to 74 years should be offered screening every 2 years, stopping if they have a life expectancy of less than 10 years. Stop screening at age 75. If you haven't already, drop the clinical breast examination. (LOE = 5)

Qaseem A, Lin JS, Mustafa RA, Horwitch CA, Wilt TJ; Clinical Guidelines Committee of the American College of Physicians. Screening for breast cancer in average-risk women: a guidance statement from the American College of Physicians. Ann Intern Med 2019;170:547-560.  [PMID:30959525]

Practice guideline

Foundation

Outpatient (any)

This statement starts with available guidelines that conflict with one another and scores them for validity using the AGREE II instrument, a guide for producing high-quality guidelines. The guideline development committee comprised members of the ACP and 2 public representatives without conflicts of interest. The resulting guidance was reviewed by the governance of the ACP. The committee scored several guidelines as low-quality based on methodology that did not have a formal means of linking benefits and harms with their recommendations or that based recommendations on observational or modeling studies to a greater extent than randomized controlled studies. Said by many but worth repeating: No studies have demonstrated a reduction in all-cause mortality with screening. Breast cancer–related mortality is reduced in women aged 50 to 69 years and 2 guidelines assert benefit for women 39 to 49 years of age. False-positive results leading to additional testing and unneeded treatment (overdiagnosis) are present in all groups, tempering benefit in women younger than 50. No studies have shown a benefit to clinical breast examination.