The American College of Radiology released new breast cancer screening guidelines on Wednesday, calling for increased vigilance among certain patient populations.
All women should undergo risk assessment by age 25 to determine if surveillance is needed earlier than their 40s. ACR emphasized the need for more intensive-screening among Black women and those of Ashkenazi Jewish decent, who face increase risk of developing the disease.
“The latest scientific evidence continues to point to earlier assessment as well as augmented and earlier-than-age-40 screening of many women—particularly Black women and other minority women,” Debra Monticciolo, MD, primary author of the new guidelines and chief of breast imaging at Massachusetts General Hospital, said in an announcement. “These evidence-based updates should spur more-informed doctor-patient conversations and help providers save more lives.”
ACR now recommends those with genetics-based predispositions, calculated lifetime risk of 20% or greater, and individuals exposed to chest radiation at a young age undergo MRI surveillance at ages 25-30. Depending on risk, they additionally should begin annual mammography screening between 25-40. Women diagnosed with breast cancer before 50 (or with a personal history of the disease and dense tissue) should have annual supplemental MRIs. And individuals who desire such screening, but who cannot receive magnetic resonance imaging, should consider contrast-enhance mammography or ultrasound.
Experts cited several motivations for the need to closely monitor minority populations. They are 72% more likely to be diagnosed with breast cancer after age 50, with a 127% greater risk of death from the disease. Black women, in particular, face a 42% higher mortality rate, despite equal incidences of the disease compared to other populations. And they face a twofold higher chance of developing more aggressive, triple-negative tumors, the guidelines note.
Since the proliferation of mammography screening in the 1980s, the breast cancer death rate dropped 43% after staying stagnant for 50 years, ACR noted. Yet, mortality rates among Black women have decreased about half as fast as those for their white counterparts since the ’90s. A recent study recommended that women in this population should start screening eight years earlier to begin addressing such disparities.
“We continue to regularly examine the latest evidence and update our recommendations to help save more Black women and others at high risk from this deadly disease,” Stamatia Destounis, MD, co-author of the new guidelines and chair of the American College of Radiology Breast Imaging Commission, said May 3.
The guidelines were published in the Journal of the American College of Radiology [1] on Wednesday (link below).
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.