Clinical practice guideline for breast cancer screening at the first level of care

Dunstan J.; Becerra-Chauca N.; Pari-Salas J.C.; Oré F.; Moreno J.M.; Valencia F.; Rúa O.; Álvarez L.; Pérez-Vargas J.C.S.; Rebaza L.; Pinto P.; Paredes J.; Carrasco M.; Hinojosa M.; Nizama-Avila M.; Napan Y.; Angulo N.; Galván N.; Velezmoro V.; Galarreta J.; Hijar G.; Charri J.C.; Montes-Alvis J.; Béjar M.; Huamán-Sanchez K.; Timaná-Ruiz R. · Anales de la Facultad de Medicina (2025) · DOI: 10.15381/anales.v86i4.31537

Resumen

Introduction. This article summarizes the clinical practice guideline (CPG) for breast cancer screening in primary health care settings. Objective. To provide health professionals with evidence-based recommendations to guide decisionmaking regarding breast cancer screening among women attending primary care facilities. Methods. A multidisciplinary guideline development group (GDG), composed of clinical specialists and methodologists, formulated prioritized clinical questions. Systematic searches of systematic reviews and, when necessary, primary studies were conducted in Medline (through Pubmed), Embase, and CENTRAL during 2023. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Through consensus meetings, the GDG reviewed the evidence and developed recommendations, good clinical practice points, and decision flowcharts. The guideline was approved by Ministerial Resolution No. 008-2024-CETS/INS. Results. The CPG addressed five clinical questions and formulated six conditional recommendations (four in favor and two against) and two flowcharts to support decision-making at the primary care level. The guideline suggests that asymptomatic women aged 40 to 69 years at low risk of developing breast cancer should undergo a clinical breast examination every two years, particularly when other screening technologies are not available. It also recommends biennial mammography for asymptomatic women aged 40–49 years and for those aged 50–69 years, both as conditional recommendations in favor of the intervention, supported by very low certainty evidence. For the 40–49 age group, the decision to perform mammography should be based on a shared decision-making process, where potential benefits and harms are discussed with the woman. Conversely, for asymptomatic women aged 40–69 years at low risk who have a negative mammogram and increased breast density (categories C or D), the guideline suggests not performing supplemental breast ultrasound or tomosynthesis, as current evidence does not demonstrate sufficient benefit (conditional recommendations against, very low certainty evidence). Finally, for women at high risk of developing breast cancer—including those with known pathogenic genetic mutations, a first-degree relative with such mutations, a history of thoracic radiotherapy before age 30, or a lifetime risk >30% according to validated models (e.g., IBIS, Gail, BOADICEA)—the guideline suggests annual magnetic resonance imaging (MRI) with contrast in addition to mammography, based on low-certainty evidence. Conclusions. This CPG provides evidence-based recommendations to optimize breast cancer screening in primary health care. Its implementation will strengthen informed clinical decision-making, promote equitable access to early detection, and support rational use of healthcare resources. © (2025), All rights reserved.

Instituciones: Universidad Católica de Santa María