ACOG 2017 Practice Bulletin 179: breast cancer screening in average-risk women

Who it applies to

Average-risk women of screening age in general obstetric-gynecologic practice, excluding those with known high-risk factors such as BRCA mutations or prior chest radiation.

Key recommendations

• Offer mammography screening starting at age 40 based on patient values and preferences, with shared decision-making about benefits and harms.
• Recommend that average-risk women begin regular mammography screening no later than age 50.
• Continue screening mammography until at least age 75, with continuation beyond that based on health status and life expectancy.
• Screening interval may be annual or biennial depending on patient preference and risk factors, recognizing a tradeoff between earlier cancer detection and higher rates of false positives with annual screening.
• Clinical breast examination may be offered to average-risk women but evidence of benefit beyond mammography alone is limited.
• Breast self-examination is not recommended as a standalone screening strategy but patients should be counseled on breast self-awareness.
• Routine risk assessment for breast cancer should be performed to identify women who may benefit from genetic counseling or earlier/supplemental screening.
• Supplemental screening with MRI or ultrasound is not recommended for average-risk women, including those with dense breasts, outside of individualized discussion.

Practice points for students

• Average-risk screening decisions should incorporate shared decision-making rather than a rigid age cutoff.
• Age 40-49 mammography benefit is smaller and false-positive risk higher than in older women, which is central to the individualized approach.
• Dense breast tissue alone does not automatically warrant supplemental imaging in average-risk women under this bulletin.
• Breast self-examination teaching is de-emphasized compared to general breast self-awareness counseling.

Condition

Other guidelines on this topic

• Metastatic breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-upESMO2026Official guideline
• Early and locally advanced breast cancer: diagnosis and management (NG101)NICE2025Official guideline
• Joint EANM-SNMMI guideline on the role of 2-[<sup>18</sup>F]FDG PET/CT in no special type breast cancer : (endorsed by the ACR, ESSO, ESTRO, EUSOBI/ESR, and EUSOMA)EANM/SNMMI2024Full text
• Systemic Treatment of Patients With Metastatic Breast Cancer: ASCO Resource-Stratified GuidelineASCO2024Full text
• The Japanese Breast Cancer Society Clinical Practice Guidelines for systemic treatment of breast cancer, 2022 editionJBCS2023Full text
• Breast imaging and cancer diagnosis during the COVID-19 pandemic: recommendations from the Italian College of Breast Radiologists by SIRMSIRM2020Full text
• DEGRO practical guideline for partial-breast irradiationDEGRO2020Full text
• Diffusion-weighted imaging of the breast-a consensus and mission statement from the EUSOBI International Breast Diffusion-Weighted Imaging working groupEUSOBI2020Full text

Independent educational summary written by the WhiteCoat Pro editorial team with AI assistance and checked by a second AI model. It does not reproduce the guideline text, tables or figures, and it is not affiliated with or endorsed by ACOG. It is not medical advice: always read the original guideline before applying it to patients.