Guidelines recommend augmented breast cancer screening for black women, others at elevated risk
The American College of Radiology and Society of Breast Imaging issued updated guidelines that are the first to suggest breast cancer screening strategies should be amended for black women.
The organizations also recommended that women previously diagnosed with breast cancer consider screening with MRI in addition to digital mammography.
The guidelines continue to recommend that women at average risk for breast cancer begin screening at age 40 years; however, they call for all women to undergo a risk assessment at age 30 years to determine if earlier screening is necessary.
“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,” Debra L. Monticciolo, MD, FACR, chair of the American College of Radiology Breast Imaging Commission, said in a press release.
HemOnc Today spoke with Monticciolo about how and why these guidelines differ from most others related to breast cancer screening, as well as the impact these guidelines could have on breast cancer detection and outcomes.
Question: What do the guidelines recommend?
Answer: These guidelines are for women at higher-than-average risk for breast cancer. First, we need to identify those at higher risk, especially black women and those of Ashkenazi Jewish descent, before the age of 30 years. The elevated risk among black women in particular has been largely underappreciated. The age of 30 is important because much of the supplemental screening should start at that age. We recommend that women with a genetics-based elevated risk or a calculated lifetime risk for breast cancer of 20% or higher undergo digital mammography — with or without tomosynthesis — annually starting at age 30 years. Additionally, women treated with chest radiation at a young age should start mammography screening at age 25 years or 8 years after the completion of the radiation treatment, whichever comes last. The aforementioned groups also should have annual breast MRI starting between the ages of 25 and 30 years. Patients with BRCA1 and BRCA2 mutations should start MRI at age 25 years.
New in these guidelines are recommendations for women who have already had breast cancer. These women should be screened annually with digital mammography, but also annually with breast MRI if they have dense breast tissue or if they were diagnosed prior to age 50 years. Women with breast cancer history who do not fall into these two categories should still consider MRI, especially if other risk factors are present.
Q: How do the guidelines differ from most other s related to breast cancer screening?
A : These guidelines are for higher-risk women, which are different from guidelines for average-risk women. Also, these guidelines present some different recommendations for higher-risk women. In this paper, we point out that black women are at higher risk. This needs to be recognized and addressed. Black women have an incidence of breast cancer equivalent to non-Hispanic whites, yet they are 40% more likely to die of breast cancer. They also have higher rates of aggressive triple-negative tumors, as well as BRCA1 and BRCA2 mutations. In addition, many black women are in underserved communities. I believe this is the first time such issues for black women are addressed in a guideline recommendation.
Another difference is the updated information for women who have a personal history of breast cancer. These women are at continued higher risk for recurrence and contralateral cancer. We recommend that MRI surveillance be added for women with a personal history of breast cancer and dense tissue, or those diagnosed with breast cancer before the age of 50 years. In the past, these women were left in limbo with the recommendation neither for nor against MRI. More data are now available to demonstrate the clear benefit of MRI for these women.
Q: What impact do you think these guidelines could have on breast cancer detection and outcomes?
A: These women are at high risk for breast cancer, and we hope to find cancers as early as possible so they are easier to treat. Early detection and treatment gives these women the best chance for a long life. We are confident that, if followed, these guidelines will do just that.
Q: Is there anything else that you would like to mention?
A: Breast cancer is the most common cancer among women. It is the second most common cause of cancer-related death among women overall, and the number one malignant cause of death among women aged 35 to 60 years. Mammography and breast MRI can find these lesions early, so we want to encourage all women to start yearly mammography starting at age 40 years — or earlier if they are at higher risk. We do not want women to wait for a later age or wait an extended time between screenings because the cancers do not wait. We truly hope to get the message out that mammography and MRI can really make a difference. – by Jennifer R. Southall
Monticciolo DL, et al. J Am Coll Radiol. 2018;15:408-414.
For more information:
Debra L. Monticciolo, MD, can be reached at Scott & White Medical Center, Department of Radiology, 2401 S. 31st St., Temple, TX 76508; email: firstname.lastname@example.org.
Disclosure: Monticciolo reports no relevant financial disclosures.