New, risk-based breast cancer screening recommendations from the American Society of Breast Surgeons (ASBrS) call for formal risk assessment for all women over the age of 25, a return to the traditional screening age for average-risk women, and earlier annual screening for those at higher risk for the disease.
The , which differ from the U.S. Preventive Services Task Force (USPSTF) and American Cancer Society (ACS) screening recommendations, were announced Friday during the group's annual meeting in Dallas.
"Initiating screening mammography at age 40 undoubtedly saves more lives through early detection of disease compared to alternative schedules, and was therefore the 'traditional' age recommended in clinical practice until approximately 10 years ago, when the USPSTF published a revised guideline," Lisa Newman, MD, MPH, chief of breast surgery at New York-Presbyterian/Weill Cornell Medicine in New York City, told ڴŮ.
For women at average risk, guidelines from the USPSTF and ACS currently call for routine screening starting at ages 50 and 45, respectively. Those groups noted harms associated with false positive screening results: unnecessary anxiety, overdiagnosis, and pain and the potential for complications from follow-up biopsies. The with screening mammography are false, according to a paper cited by the guideline authors.
The ASBrS statement also acknowledged "known disadvantages" of mammography in the 40-49 age group and said women "should be informed of the potential downsides."
Nevertheless, "the ASBrS position statement advocates for annual screening mammography beginning at age 40 years, because we have chosen to prioritize the life-saving benefits of screening mammography," said Newman, who served on the committee that developed the ASBrS guidelines. "Furthermore, as physicians that guide patients through decisions regarding management of breast cancer on a daily basis, we have unique perspectives regarding the value of early detection and its impact on surgical as well as systemic and radio-therapeutic options."
ASBrS Position
In all scenarios, tomosynthesis (or 3D mammography) is the preferred option for mammography screening, according to the guidance, which was developed by an ASBrS panel and co-chaired by Shawna Willey, MD, of Washington's Medstar Georgetown University Hospital, and Pat Whitworth, MD, of the Nashville Breast Center in Tennessee.
For average-risk women, the ASBrS guidance calls for all women to receive annual mammograms starting at age 40, and recommends that supplemental imaging be considered for those with higher breast density (C and D, heterogeneously or extremely dense).
For women at higher risk of breast cancer due to hereditary susceptibility genes or prior radiation to the chest wall, ASBrS recommends annual MRI starting at age 25, and annual mammography starting at 30.
For women at higher risk due to a strong family history, or who have a predicted lifetime risk greater than 20% on the Claus, BRCAPRO, or Tyrer-Cuzick risk-assessment models, the society recommends annual mammograms starting at age 35 and access to supplemental imaging when recommended by their physician (MRI preferred).
"At this point in time we have the most robust data regarding breast cancer risk and screening benefits among women with pathogenic mutations in the BRCA1 and BRCA2 genes," Newman said. "History of therapeutic chest wall radiation during adolescence/early adulthood and women with strong family histories of early onset breast cancer (even if a pathogenic mutation has not been identified in the family) represent other examples where mammographic screening at younger ages, as well as supplemental screening with breast MRI, should be considered."
For women ages 50 and older with a history of breast cancer, the ASBrS position statement calls for annual mammography. For women with a history of cancer who are younger than 50 or who have dense breasts, the group calls for annual mammograms and access to supplemental imaging when recommended by their physician (MRI preferred).
Women with a life expectancy of less than 10 years should no longer receive breast cancer screening, according to the ASBrS.
Newman noted that the group's position statement is unique because of the emphasis on the importance of screening mammography as a means of addressing breast cancer disparities.
"African American women have a younger age distribution for breast cancer compared to white American women, and are more likely to be diagnosed with the biologically aggressive triple-negative phenotype at all ages," she said. "These patterns undoubtedly contribute to the higher breast cancer mortality rates that are seen in African American women. The ASBrS mammography screening recommendation is clear, it's evidence-based, and it presents an opportunity to reduce race/ethnicity-associated breast cancer disparities by improving early detection among all women."
Primary Source
American Society of Breast Surgeons
"Position statement on screening mammography" ASBrS 2019.