An Evidence-based and Inclusive Breast Cancer Screening Strategy: Summary of Current Guidelines from the American College of Radiology and Society of Breast Imaging.

Abstract

HomeRadiology: Imaging CancerVol. 4, No. 2 PreviousNext Research HighlightsFree AccessAn Evidence-based and Inclusive Breast Cancer Screening Strategy: Summary of Current Guidelines from the American College of Radiology and Society of Breast ImagingDevan Diwanji, Bonnie JoeDevan Diwanji, Bonnie JoeDevan DiwanjiBonnie JoePublished Online:Mar 18 2022https://doi.org/10.1148/rycan.229003MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Take-Away Points■ Major Focus: For persons at average risk, initiating annual screening mammography at age 40 years confers the greatest reduction in breast cancer mortality with diagnosis at earlier stages and better options for surgery and chemotherapy.■ Key Result: Screening should continue past age 74 years without upper age limit unless significant comorbidities limit life expectancy.■ Impact: Breast cancer risk assessment should be performed by age 30 years, especially in Black, Asian, and Hispanic women, to appropriately define risk category for each person.Breast cancer is the most common nonskin cancer and the second leading cause of cancer death in women. Although advances in treatments have significantly improved survival, they alone cannot overcome the disadvantage of a late-stage cancer diagnosis. Regular breast cancer screening with mammography reduces mortality by approximately 40% for women age 40 years and older. Experts from the American College of Radiology (ACR) and Society of Breast Imaging (SBI) reviewed data from numerous trials and imaging studies to offer evidence-based recommendations for screening mammography. Recommendations focused on reducing morbidity and mortality while addressing screening disparities and risks of screening versus not screening.The ACR and SBI recommend annual screening mammography starting at age 40 years for individuals at average risk. Starting at age 40 years versus 45 or 50 years helps detect cancer at earlier stages in which smaller tumor burdens and less metastatic potential broaden effective therapeutic options. Annual screening helps identify cancers with potential to grow and metastasize during longer screening interval periods. More than one-third of breast cancer deaths and nearly half for women age 40–49 years manifested in the 2nd year after mammography with negative findings. Because one in five breast cancers occur in women age 75 years and older, the ACR and SBI recommend screening past 75 years of age with consideration for comorbidities that limit life expectancy. More frequent screening increases benign-outcome recalls and biopsies but should be balanced against benefits of gained life-years and fewer deaths from breast cancer. Overdiagnosis from mammography screening occurs in less than 1% of women younger than 60 years of age, independent of screening interval or age to begin screening. A single mammography examination provides minimal radiation, equivalent to 6 weeks of natural background radiation. The ratio of lives saved by mammography compared with the theoretical possibility of lives lost from increased radiation exposure is 50–75 to one. Both benefits and risks should be considered to help individuals make informed choices regarding screening.The ACR and SBI recommendations address racial disparities associated with less frequent or delayed screening. Racial and ethnic minority women younger than 50 years old are 72% more likely to be diagnosed with invasive breast cancer than non-Hispanic White women. One-third of breast cancers in Black, Asian, and Hispanic women are diagnosed before 50 years of age. Biological factors, including higher incidences of mutations in BRCA1 and BRCA2 and aggressive triple-negative disease in racial and ethnic minority women, as well as systemic inequities in access to screening mammography may contribute to these discrepancies. Earlier or more frequent screening may detect cancers earlier in racial and ethnic minority women and mitigate some differences.Highlighted ArticleMonticciolo DL, Malak SF, Friedewald SM, et al. Breast cancer screening recommendations inclusive of all women at average risk: update from the ACR and Society of Breast Imaging. J Am Coll Radiol 2021; 18(9):1280–1288. doi: https://doi.org/10.1016/j.jacr.2021.04.021Highlighted ArticleMonticciolo DL, Malak SF, Friedewald SM, et al. Breast cancer screening recommendations inclusive of all women at average risk: update from the ACR and Society of Breast Imaging. J Am Coll Radiol 2021;18(9):1280–1288. doi:https://doi.org/10.1016/j.jacr.2021.04.021 Crossref, Medline, Google ScholarArticle HistoryPublished online: Mar 18 2022 FiguresReferencesRelatedDetailsRecommended Articles Age-based versus Risk-based Mammography Screening in Women 40–49 Years Old: A Cross-sectional StudyRadiology2019Volume: 292Issue: 2pp. 321-328Sustainable Benefits of Digital Breast Tomosynthesis ScreeningRadiology2020Volume: 298Issue: 1pp. 58-59Non-BRCA Early-Onset Breast Cancer in Young WomenRadioGraphics2022Volume: 42Issue: 1pp. 5-22Digital Mammography and Breast Tomosynthesis Performance in Women with a Personal History of Breast Cancer, 2007–2016Radiology2021Volume: 300Issue: 2pp. 290-300Invited Commentary: The Challenges of Early-Onset Breast CancerRadioGraphics2022Volume: 42Issue: 1pp. E16-E17See More RSNA Education Exhibits How to Identify Women Who Are Above Average Risk for Developing Breast Cancer: Retrospective Review of our Institution's First Year Experience After Implementing a Breast Cancer Risk Assessment Program in Breast ImagingDigital Posters2018High Risk Breast Cancer Screening  Digital Posters2020Non-Contrast-Enhanced Breast MR Screening for Women with Dense BreastsDigital Posters2019 RSNA Case Collection Multifocal breast cancerRSNA Case Collection2020Male invasive Ductal Carcinoma RSNA Case Collection2022Invasive ductal carcinoma of the breastRSNA Case Collection2020 Vol. 4, No. 2 Metrics Altmetric Score PDF download