ACR, Society of Breast Imaging issue updated guidance for screening women with average cancer risk

The American College of Radiology and Society of Breast Imaging recommend that women begin receiving annual mammograms at age 40, with added vigilance for those in historically overlooked populations.

Both shared updated guidance in the Journal of the American College of Radiology on June 18. Their recommendations are based on an “extensive” data from randomized controlled trials and peer-reviewed literature.

“Since our most recent guideline, new data are available to evaluate the impact of screening using advanced-stage and fatal breast cancers, to assess the utilization and benefits of [digital breast tomosynthesis], and to evaluate disparities in breast cancer screening and treatment among minority women,” Debra Monticciolo, MD, vice chair of the department of radiology and section chief of breast imaging at Baylor Scott & White Medical Center-Temple, and co-authors wrote Friday. “With this guideline, we offer recommendations more inclusive of all women of average risk for breast cancer.”

ACR continues to recommend annual mammography starting at age 40, touting studies showing that regular screening can reduce deaths by 40%. Delaying screening until age 45 or 50, as some have advocated, results in “unnecessary loss of life,” a concern that adversely affects minority women.

Screening should continue past age 74, the groups noted, without an upper age limit, unless severe comorbidities limit life expectancy. ACR and SBI underlined the risk in not screening, with treatment advancements incapable of overcoming the disadvantages of being diagnosed with an advanced stage of the disease.

Monticciolo et al. additionally highlighted disparities in care, with non-Hispanic Black women at 40% higher risk of dying from breast cancer compared to their white counterparts.  Higher incidence of BRCA1 and BRCA2 mutations, along with twice the rate of triple-negative breast cancers, all contribute to these disparities. To address such factors, the authors recommended providing all women with earlier risk assessments and equal access to high-quality screening mammography starting at age 40.

LGBTQ individuals are also less likely to present for regular imaging checkups than other patients. Radiology providers must create respectful environments to welcome them, the authors said. Screening guidance for average-risk transgender patients depends on the sex assigned at birth, hormone use and surgical history. For instance, transfeminine (male-to-female) patients who have used hormones for greater than five years should start annual screening at age 40. Same for transmasculine (female-to-male) patients who have not had a mastectomy.

You can read the rest of the guidance in JACR here.

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