Newswise — Philadelphia, May 4, 2023 – The revised breast cancer screening guidelines from the American College of Radiology® (ACR®) now suggest that all females, particularly those of Black and Ashkenazi Jewish descent, should undergo risk evaluation by age 25 to ascertain if screening before age 40 is necessary. While yearly screening from age 40 is still recommended for females at average risk, high-risk patients are advised to have earlier and more extensive screening. The ACR's updated guidelines for high-risk females were made public on May 3 in the Journal of the American College of Radiology (JACR).

Other Notable Updates:

  • Women with genetics-based increased risk (including BRCA1 carriers), those with a calculated lifetime risk of 20% or more and those exposed to chest radiation at a young age are recommended to have MRI surveillance starting at ages 25 to 30. These women should start annual mammography at ages 25 to 40, depending on type of risk.
  • Women diagnosed with breast cancer prior to age 50 or with personal history of breast cancer and dense breasts should have annual supplemental breast MRI.
  • High-risk women who desire supplemental screening — but cannot undergo MRI screening — should consider contrast-enhanced mammography (CEM).

Debra Monticciolo, MD, FACR, who is the primary author of the updated guidelines and division chief of Breast Imaging at Massachusetts General Hospital in Boston, stated that the most recent scientific research reinforces the need for earlier risk evaluation and intensified screening for several women, especially Black women and other minority groups. "These evidence-based modifications should encourage more informed discussions between doctors and patients and aid providers in saving more lives," she added.

Factors that contributed to the ACR reclassification of Black women and other minorities to high-risk include that, compared to non-Hispanic white women:

  • Prior to age 50, minority women are: 127% more likely to die of breast cancer; 72% more likely to be diagnosed with breast cancer; and 58% more likely to be diagnosed with advanced-stage breast cancer.
  • Black women are 42% more likely to die from breast cancer despite roughly equal incidence rates.
  • Black women are less likely to be diagnosed with stage I breast cancer but twice as likely to die of early breast cancers.
  • Black women have a two-fold higher risk of aggressive — “triple-negative” — breast tumors and a higher risk of BRCA1 and BRCA2 genetic mutations (placing them at higher risk).

Stamatia Destounis, MD, FACR, who is the co-author of the updated guidelines, chair of the American College of Radiology Breast Imaging Commission, and managing partner at Elizabeth Wende Breast Care in Rochester, NY, highlighted that breast cancer death rates in Black women have only decreased at half the rate of white women since 1990, despite the fact that Black women develop and succumb to the disease earlier. She emphasized the need to review the most recent scientific evidence regularly and update the recommendations accordingly to aid in the prevention of breast cancer and the saving of more lives, particularly those of Black women and others at high risk.

The National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) data indicates that since the widespread adoption of mammography in the 1980s, the breast cancer death rate in women in the United States, which had remained unchanged for the previous 50 years, has decreased by 43%. However, breast cancer deaths in men, who receive the same treatment as women but are not routinely screened for breast cancer, have not shown a decline.

For more information regarding the proven effectiveness of regular mammography screening at reducing breast cancer deaths, please visit RadiologyInfo.orgMammographySavesLives.org and EndTheConfusion.org.

Journal Link: Journal of the American College of Radiology (JACR)