New ACR/SBI Breast Cancer Screening Guidelines

New American College of Radiology (ACR) and Society of Breast Imaging (SBI) breast cancer screening guidelines are the first to recognize that African-American women are at high-risk for the disease and should be screened as such. The ACR and SBI now call for all women to have a risk assessment at age 30 to see if screening earlier than age 40 is needed. The societies also newly-recommend that women previously diagnosed with breast cancer be screened with magnetic resonance imaging (MRI).

The ACR and SBI continue to recommend that women at average breast cancer risk begin screening at age 40.

“The latest scientific evidence overwhelmingly supports a continued general recommendation of starting annual screening at age 40. It also supports augmented and earlier screening for many women. These updates will help save more lives,” said Debra Monticciolo, MD, FACR, chair of the American College of Radiology Breast Imaging Commission.

According to 2015 National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) data, since mammography became widespread in the 1980s, the U.S. breast cancer death rate in women, unchanged for the previous 50 years, has dropped 43 percent. Breast cancer deaths in men, who have the same treatment as women but are not screened, have not declined.

Factors that contributed to the ACR/SBI reclassification of African-American women include that:

• African-American women are 42 percent more likely to die from breast cancer than non-Hispanic white women despite roughly equal incidence rates


• African-American women have a two-fold higher risk of aggressive — “triple-negative” — breast tumors


• African-American women are less likely to be diagnosed with stage I breast cancer, but twice as likely to die of early breast cancers


• African-American women have a higher risk of BRCA1 and BRCA2 genetic mutations than those of Western European ancestry. These carriers are at much higher risk for breast cancer.

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  For women with genetics-based increased risk (and their untested first-degree relatives) or with a calculated lifetime risk of 20% or more, DM, with or without DBT, should be performed annually beginning at age 30.

  
  


• For women with histories of chest radiation therapy before the age of 30, DM, with or without DBT, should be performed annually beginning at age 25 or 8 years after radiation therapy, whichever is later.


• For women with genetics-based increased risk (and their untested first-degree relatives), histories of chest radiation (cumulative dose of ≥10 Gy before age 30), or a calculated lifetime risk of 20% or more, breast MRI should be performed annually beginning at age 25 to 30.


• For women with personal histories of breast cancer and dense breast tissue or those diagnosed before age 50, annual surveillance with breast MRI is recommended.


• For women with personal histories not included in the above, or with ADH, atypical lobular hyperplasia, or LCIS, MRI should be considered, especially if other risk factors are present.


• All women, especially black women and those of Ashkenazi Jewish descent, should be evaluated for breast cancer risk no later than age 30, so that those at higher risk can be identified and can benefit from supplemental screening.

“Since 1990, breast cancer death rates dropped 23 percent in African-American women — approximately half that in whites. We changed our approach to help save more African-American women and others at higher risk from this deadly disease,” said Wendy B. DeMartini, MD, FSBI.