A Guide to a Guidance Statement on Screening Guidelines
Authors: Joann G. Elmore, Christoph I. Lee
Journal: Annals of Internal Medicine (2019)

Editorials16 April 2019A Guide to a Guidance Statement on Screening GuidelinesJoann G. Elmore, MD, MPH and Christoph I. Lee, MD, MSJoann G. Elmore, MD, MPHDavid Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California (J.G.E.)Search for more papers by this author and Christoph I. Lee, MD, MSUniversity of Washington School of Medicine, Seattle, Washington (C.I.L.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-0726 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In this issue, the American College of Physicians (ACP) Clinical Guidelines Committee presents its assessment of the quality and content of 7 English-language guidelines for breast cancer screening (1). The results of the assessment are 4 guidance statements that provide clarity and simplicity amidst the chaos of diverging guidelines. ACP guidance statements represent convergence across differing recommendations while highlighting important points for physicians to consider in shared decision-making conversations with their patients about routine breast cancer screening.Variability in the interpretation of medical data has long been studied (2) and is a known phenomenon in breast cancer screening, both in ...References1. Qaseem A, Lin JS, Mustafa RA, Horwich 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;170:547-60. doi:10.7326/M18-2147 LinkGoogle Scholar2. Elmore JG, Feinstein AR. A bibliography of publications on observer variability (final installment). J Clin Epidemiol. 1992;45:567-80. [PMID: 1607896] CrossrefMedlineGoogle Scholar3. Elmore JG, Wells CK, Lee CH, Howard DH, Feinstein AR. Variability in radiologists' interpretations of mammograms. N Engl J Med. 1994;331:1493-9. [PMID: 7969300] CrossrefMedlineGoogle Scholar4. Norris SL, Burda BU, Holmer HK, Ogden LA, Fu R, Bero L, et al. Author's specialty and conflicts of interest contribute to conflicting guidelines for screening mammography. J Clin Epidemiol. 2012;65:725-33. [PMID: 22498428] doi:10.1016/j.jclinepi.2011.12.011 CrossrefMedlineGoogle Scholar5. Haas JS, Kaplan CP, DesJarlais G, Gildengoin V, Pérez-Stable EJ, Kerlikowske K. Perceived risk of breast cancer among women at average and increased risk. J Womens Health (Larchmt). 2005;14:845-51. [PMID: 16313212] CrossrefMedlineGoogle Scholar6. Egger JR, Cutter GR, Carney PA, Taplin SH, Barlow WE, Hendrick RE, et al. Mammographers' perception of women's breast cancer risk. Med Decis Making. 2005;25:283-9. [PMID: 15951455] CrossrefMedlineGoogle Scholar7. Zagoudis J. Congress directs FDA to establish federal breast density inform standard. Imaging Technology News. 19 February 2019. Accessed at www.itnonline.com/content/congress-directs-fda-establish-federal-breast-density-inform-standard on 4 March 2019. Google Scholar8. Cappello NM, Richetelli D, Lee CI. The impact of breast density reporting laws on women's awareness of density-associated risks and conversations regarding supplemental screening with providers. J Am Coll Radiol. 2019;16:139-46. [PMID: 30287178] doi:10.1016/j.jacr.2018.08.009 CrossrefMedlineGoogle Scholar9. Smetana GW, Elmore JG, Lee CI, Burns RB. Should this woman with dense breasts receive supplemental breast cancer screening? Grand rounds discussion from Beth Israel Deaconess Medical Center. Ann Intern Med. 2018;169:474-84. [PMID: 30285208]. doi:10.7326/M18-1822 LinkGoogle Scholar10. Lee CI, Lee JM. Maximizing value through innovations in radiologist-driven communications in breast imaging. AJR Am J Roentgenol. 2017;209:1001-5. [PMID: 28726506] doi:10.2214/AJR.17.18410 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California (J.G.E.)University of Washington School of Medicine, Seattle, Washington (C.I.L.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-0726.Corresponding Author: Joann G. Elmore, MD, MPH, Department of Medicine, David Geffen School of Medicine at UCLA, 1100 Glendon Avenue, Suite 900, Los Angeles, CA 90024; e-mail, [email protected]ucla.edu.Current Author Addresses: Dr. Elmore: Department of Medicine, David Geffen School of Medicine at UCLA, 1100 Glendon Avenue, Suite 900, Los Angeles, CA 90024.Dr. Lee: University of Washington School of Medicine, 1144 Eastlake Avenue East, LG-200, Seattle, WA 98109.This article was published at Annals.org on 9 April 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoScreening for Breast Cancer in Average-Risk Women: A Guidance Statement From the American College of Physicians Amir Qaseem , Jennifer S. Lin , Reem A. Mustafa , Carrie A. Horwitch , Timothy J. Wilt , and Metrics Cited byHarms and Benefits of Cancer Screening 16 April 2019Volume 170, Issue 8Page: 573-574KeywordsBreast cancerBreast cancer screeningCancer screeningLife expectancyMammographyMedical risk factorsOral contraceptive therapyRadiologistsRisk managementScreening guidelines ePublished: 9 April 2019 Issue Published: 16 April 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...