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Many women qualify for breast cancer screening before recommended age
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Half of women aged 40 to 44 years had an elevated risk for breast cancer and qualified for screening earlier than the recommended age of 45 years, according to an institutional database review presented at the American Society of Breast Surgeons Annual Meeting.
A formal risk assessment is necessary to identify women who would qualify for early mammography, screening MRIs and genetics testing, according to the researchers.
“Many women do not focus on breast cancer issues until they begin regular mammograms. As a result, women may remain unaware that screening at an earlier age is important for their health,” Kevin Hughes, MS, FACS, co-director of Avon Foundation Comprehensive Breast Evaluation Center at Massachusetts General Hospital, as well as medical director of the Bermuda Cancer Genetics and Risk Assessment Clinic and associate professor of surgery at Harvard Medical School, said in a press release.
American Cancer Society guidelines updated in 2015 adjusted the recommended age for average-risk women to commence screening from 40 years to 45 years. Women with an elevated risk should begin screening prior to that age.
The American Society of Breast Surgeons 2015 guidelines also recommend screening mammograms for women with a lifetime breast cancer risk of 15% to 20%, with MRI recommended for women if their risk is 20% or higher.
“The new guidelines are a bit of a catch 22," Hughes said. “Certain conditions will only become clear through mammography and related procedures now recommended to start at age 45. Few women undergo risk assessment, which can be complex and time-consuming and involves information such as a women's child-bearing history, age of first menstrual cycle and family members diagnosed with cancer.”
In their specialty practice at Massachusetts General Hospital, Hughes and colleagues aimed to identify the number of women aged 40 to 44 years who would meet eligibility requirements for screening mammograms, genetic testing and MRIs based on the new guidelines. Researchers determined if women had a 5% or greater chance of harboring a BRCA mutation using the Tyrer-Cuzick, Myriad or the BRCAPRO models, in addition to using National Comprehensive Cancer Network guidelines.
Researchers drew from a pool of 6,964 women aged 40 years or older who did not have a diagnosis of cancer and were seen as new patients at their practice. Of these women, 909 women were aged 40 to 44 years.
Overall, 39% (n = 352) of the younger cohort were deemed eligible to begin screening at age 40 years based on ACS criteria. An additional 11% (n = 103) were eligible for early screening by the American Society of Breast Surgeons guidelines.
“The number of women found to have above average risk between age 40 and 44 was extremely surprising, and the message is clear,” Hughes said. “Our study was large and comprehensive.”
Further, 127 (13.8%) women qualified for screening MRI, 59 (6.5%) were at risk for a suspected genetic mutation, and 166 (18.3%) qualified for both MRI and genetic testing.
“A growing body of evidence points to a similar conclusion: If your doctor adheres to the new recommendations for breast screening, actively seek out a formal risk assessment, whether or not it is specifically suggested, to make sure you receive the care you need,” Hughes said. “A formal risk assessment by a qualified physician is crucial before a doctor recommends delaying regular screening mammography until age 45." – by Nick Andrews
Reference :
Hughes K, et al. Application of the 2015 ACS and ASBrS screening mammography guidelines: Risk assessment is critical for women ages 40-44. Presented at: American Society of Breast Surgeons Annual Meeting; April 13-17, 2016; Dallas, Texas.
Disclosure : HemOnc Today could not confirm the researchers’ relevant financial disclosures at the time of reporting.
Perspective
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Anees B. Chagpar, MD, MSc, MBA, MA, MPH, FACS, FRCS(C)
The new mammography screening guidelines have caused significant angst for women and advocates who question why screening mammography is no longer being mandated to stop at age 40 years. What needs to be understood is that these guidelines are for women at average risk.
In this study, Hughes and colleagues found that half of all women aged 40 to 44 years presenting to a large academic center were at increased risk, such that they may (a) qualify for earlier screening mammography, (b) have additional imaging, and/or (c) need genetic counselling. How well these data reflect the general population is unclear as this is a select group, but the message remains clear — women need to know their risk.
The models used in the Hughes study are often not readily accessible to clinicians functioning outside a high-risk clinic. Therefore, there is a need for global education of women and their primary care physicians to understand when they ought to seek more formal risk assessment. Certainly, a family history is a key risk factor, but other factors such as a previous history of atypia, lobular carcinoma in situ and radiation therapy to the chest would all put women at increased risk, regardless of their family history. Knowing your risk is critical in determining whether the current guidelines are applicable to you.
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