American Society of Breast Surgeons screening mammography guidelines recommend early assessment

New guidelines from the American Society of Breast Surgeons recommend women with average risk for breast cancer begin annual screening mammography at age 40 years, following a formal risk assessment as early as age 25 years.

The guidelines differ from those published by the U.S. Preventive Services Task Force, which call for average-risk women to start screening at age 50 years and continue biennially through age 74 years, and American Cancer Society, which advise annual screening for average-risk women starting at age 45 years and continuing until age 54 years, with biennial screening beginning at age 55 years.

The American Society of Breast Surgeons guidelines, based on individual breast cancer risk profile, specifically did not factor in insurance barriers but do address specific breast cancer subtypes that are more common among certain racial and ethnic groups.

“Our members are on the frontlines with [patients with] breast cancer every day, guiding them through all stages of breast cancer diagnosis and treatment,” Shawna C. Willey, MD, FACS, chair of the American Society of Breast Surgeons board, and professor of clinical surgery, director of the MedStar Regional Breast Health Program and chief of surgery at MedStar Georgetown University Hospital, said in a press release. “These new recommendations were [American Society of Breast Surgeons] member-driven and developed based on their unique, firsthand perspective on the disease and patient journey. They represent a deep, passionate and scientifically backed commitment to advocate for increased years of life over costs. They also aim to minimize breast cancer disparities across race and ethnicity through earlier disease detection for all.”

The guidelines recommend women age 25 years — or when they first see a breast physician between the ages of 25 and 30 years — undergo formal risk assessment that includes evaluation of family history of malignancies and discussion of genetic testing and determination of prior history of atypical hyperplasia or lobular carcinoma in situ, and chest or mantle radiation therapy.

Women who are aged 30 years or older when they first see a breast physician also should undergo risk assessment using the Tyrer-Cuzick model or another comparable model.

Those with a higher-than-average risk — meaning they have a BRCA gene mutation or other germline mutation, or a history of chest irradiation — should receive annual 3D screening mammography and should have access to supplemental imaging with an additional modality, preferably MRI, when recommended by a physician.

Annual screening is not recommended for women aged younger than 40 years with an average risk for breast cancer.

Women with a prior history of breast cancer who underwent unilateral mastectomy should have yearly mammography in the contralateral breast. Women who underwent breast-conserving therapy should undergo yearly mammography of the cancerous breast.

The guidelines also recommend supplemental imaging for women with a personal history of breast cancer who also have dense breast tissue or were aged younger than 50 years at diagnosis.

De-escalation of screening is based on life expectancy and mirrors the American Cancer Society guidelines. If a woman has a life expectancy of at least 10 years, she should continue to be screened annually, according to the guidelines. If life expectancy is less than 10 years, screening may be unnecessary.

Julie Margenthaler, MD, FACS
Julie Margenthaler

“[American Society of Breast Surgeons] guidelines are based on a life-years gained model,” Julie Margenthaler, MD, FACS, director of breast surgical services in the Joanne Knight Breast Center at Siteman Cancer Center, and professor of surgery at Washington University School of Medicine in St. Louis, said in a press release. “They are based solely on the demonstrated breast cancer survival benefits. We believe women should have an opportunity to choose earlier screening if potentially beneficial. Additionally, our understanding of breast cancer risks and risk assessment has advanced. Managing screening based on those risks is an important part of today’s personalized medicine.” – by John DeRosier

Reference:

American Society of Breast Surgeons. Position statement on screening mammography. Available at: www.breastsurgeons.org/docs/statements/Position-Statement-on-Screening-Mammography.pdf. Accessed on May 10, 2019.

Disclosures: Willey and Margenthaler report no relevant financial disclosures. Please see the guidelines for all other authors’ relevant financial disclosures.

New guidelines from the American Society of Breast Surgeons recommend women with average risk for breast cancer begin annual screening mammography at age 40 years, following a formal risk assessment as early as age 25 years.

The guidelines differ from those published by the U.S. Preventive Services Task Force, which call for average-risk women to start screening at age 50 years and continue biennially through age 74 years, and American Cancer Society, which advise annual screening for average-risk women starting at age 45 years and continuing until age 54 years, with biennial screening beginning at age 55 years.

The American Society of Breast Surgeons guidelines, based on individual breast cancer risk profile, specifically did not factor in insurance barriers but do address specific breast cancer subtypes that are more common among certain racial and ethnic groups.

“Our members are on the frontlines with [patients with] breast cancer every day, guiding them through all stages of breast cancer diagnosis and treatment,” Shawna C. Willey, MD, FACS, chair of the American Society of Breast Surgeons board, and professor of clinical surgery, director of the MedStar Regional Breast Health Program and chief of surgery at MedStar Georgetown University Hospital, said in a press release. “These new recommendations were [American Society of Breast Surgeons] member-driven and developed based on their unique, firsthand perspective on the disease and patient journey. They represent a deep, passionate and scientifically backed commitment to advocate for increased years of life over costs. They also aim to minimize breast cancer disparities across race and ethnicity through earlier disease detection for all.”

The guidelines recommend women age 25 years — or when they first see a breast physician between the ages of 25 and 30 years — undergo formal risk assessment that includes evaluation of family history of malignancies and discussion of genetic testing and determination of prior history of atypical hyperplasia or lobular carcinoma in situ, and chest or mantle radiation therapy.

Women who are aged 30 years or older when they first see a breast physician also should undergo risk assessment using the Tyrer-Cuzick model or another comparable model.

Those with a higher-than-average risk — meaning they have a BRCA gene mutation or other germline mutation, or a history of chest irradiation — should receive annual 3D screening mammography and should have access to supplemental imaging with an additional modality, preferably MRI, when recommended by a physician.

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Annual screening is not recommended for women aged younger than 40 years with an average risk for breast cancer.

Women with a prior history of breast cancer who underwent unilateral mastectomy should have yearly mammography in the contralateral breast. Women who underwent breast-conserving therapy should undergo yearly mammography of the cancerous breast.

The guidelines also recommend supplemental imaging for women with a personal history of breast cancer who also have dense breast tissue or were aged younger than 50 years at diagnosis.

De-escalation of screening is based on life expectancy and mirrors the American Cancer Society guidelines. If a woman has a life expectancy of at least 10 years, she should continue to be screened annually, according to the guidelines. If life expectancy is less than 10 years, screening may be unnecessary.

Julie Margenthaler, MD, FACS
Julie Margenthaler

“[American Society of Breast Surgeons] guidelines are based on a life-years gained model,” Julie Margenthaler, MD, FACS, director of breast surgical services in the Joanne Knight Breast Center at Siteman Cancer Center, and professor of surgery at Washington University School of Medicine in St. Louis, said in a press release. “They are based solely on the demonstrated breast cancer survival benefits. We believe women should have an opportunity to choose earlier screening if potentially beneficial. Additionally, our understanding of breast cancer risks and risk assessment has advanced. Managing screening based on those risks is an important part of today’s personalized medicine.” – by John DeRosier

Reference:

American Society of Breast Surgeons. Position statement on screening mammography. Available at: www.breastsurgeons.org/docs/statements/Position-Statement-on-Screening-Mammography.pdf. Accessed on May 10, 2019.

Disclosures: Willey and Margenthaler report no relevant financial disclosures. Please see the guidelines for all other authors’ relevant financial disclosures.