New ACR Guidelines Emphasize Earlier Mammography Screening for High-Risk Women

Noting emerging literature support for supplemental imaging and earlier screening for women at high risk of breast cancer, the American College of Radiology (ACR) has updated its breast cancer screening guidelines.

Published online in the Journal of the American College of Radiology, the updated ACR breast cancer guidelines now recommend that annual digital mammography begin between the ages of 25 and 40 for women at high risk for breast cancer.

Emphasizing an ACR reclassification of Black women and other minority women as being at high risk for breast cancer, the authors of the updated recommendations noted continued disparities with respect to breast cancer mortality rates and advanced stage diagnosis.

In comparison to non-Hispanic White women, minority women are 58 percent more likely to have an advanced-stage breast cancer diagnosis and are 127 percent more likely to die from breast cancer before the age of 50, according to the authors of the guidelines. They noted that Black women, in particular, have double the risk of triple-negative breast tumors and have a 42 percent higher mortality risk for breast cancer in comparison to non-Hispanic White women.

“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. These evidence-based updates should spur more informed doctor-patient conversations and help providers save more lives,” emphasized Debra Monticciolo, M.D., F.A.C.R., the lead author of the updated ACR breast cancer screening recommendations and division chief of breast imaging at the Massachusetts General Hospital in Boston, in an ACR press release.

(Editor’s note; For related content, see “Should Race and Ethnicity Factor into Starting Ages for Mammography Screening?,” “New Meta-Analysis Says MRI is Best Supplemental Imaging for Dense Breasts” and “Study Looks at Contributing Factors to Incomplete Follow-Up for BI-RADS 3 Findings.”)

Other updated recommendations included annual supplemental magnetic resonance imaging (MRI) for women with dense breasts at the age of 40 or earlier if they have other risk factors for breast cancer. In lieu of MRI, the ACR said women with dense breasts may consider alternative supplemental imaging such as contrast-enhanced mammography (CEM) or ultrasound.

Depending on the type of risk factors, the ACR also recommends initiation of annual mammography at the age of 30 and annual MRI surveillance between the ages of 25 to 30 for women with increased genetic risk of breast cancer and those with a lifetime breast cancer risk of greater than or equal to 20 percent.

For women who have been exposed to 10 Gy or greater cumulative chest radiation by the age of 30, the updated ACR breast cancer screening guidelines recommend the initiation of annual mammography screening at the age of 25 or eight years after radiation exposure. The ACR also recommends MRI surveillance in this population between the ages of 25 to 30.