Medical organization recommends breast cancer risk assessment for all women by age 25
Click Here to Manage Email Alerts
Key takeaways:
- The guideline aims to identify high-risk women who would benefit from earlier breast cancer screening.
- Black and Ashkenazi Jewish women in particular may benefit from earlier screening.
The American College of Radiology, or ACR, updated its guidance to recommend that all women receive a breast cancer risk assessment by the age of 25 years to determine if screening is needed earlier than age 40 years.
Black and Ashkenazi Jewish women were specifically highlighted by ACR as those who may benefit from earlier screening.
The organization said it continues to recommend annual breast cancer screening for average-risk women starting at age 40 years, but “earlier and more intensive screening” should be conducted for high-risk patients.
Other guideline updates from ACR, published in the Journal of the American College of Radiology, recommend:
- an MRI starting at ages 25 to 30 years in women with genetics-based increased risk, those with a calculated lifetime risk of 20% or more and those exposed to chest radiation at a young age;
- annual supplemental breast MRI in women diagnosed with breast cancer prior to age 50 years or with a personal history of breast cancer and dense breasts; and
- considering contrast-enhanced mammography in high-risk women who would like supplemental screening but cannot undergo MRI screening.
The ACR’s guidelines, first published in 2018, had previously advocated for all women to be given breast cancer risk assessments no later than age 30 years.
Stamatia Destounis, MD, FACR, FSBI, FAIUM, chair of the ACR Breast Imaging Commission and a managing partner at Elizabeth Wende Breast Care, LLC, in New York, told Healio the updates were written to recommend a risk assessment evaluation for all women by age 25 “so we can identify the patients who are at higher risk for breast cancer because of factors such as strong family history, genetics-based increased risk, chest wall radiation at a young age, and others as these patients will require starting screening at a younger age and will benefit from supplemental screening with MRI.”
The ACR’s guidance differs from recent recommendations from the U.S. Preventive Services Task Force, which encourage screening all women aged 40 to 74 years for breast cancer every other year. The task force was unable to determine whether women with dense breasts should have additional screening with breast ultrasound or MRI.
Destounis disagreed with the USPSTF recommendations, saying they “will allow breast cancers to grow as the interval between screening will be 2 years instead of one.”
“The cancers detected will be diagnosed at more advanced stages and will require more aggressive treatment,” she said. “We think screening should be yearly to offer these young women every opportunity for the cancer to be found early, so they have a better prognosis [and] better quality of life. They don't need as much surgical intervention or chemotherapy.”
Destounis also disagreed with the USPSTF’s decision to not provide a recommendation for or against biannual screenings past age 74 years based on a lack of evidence.
“There should be no upper age limit to stop screening,” she said. “It should really be based on each woman's health status. If you’re healthy enough, you should be able to go in and get screened yearly. Finding a small tumor in a 75-year-old in overall good health will allow her to have minimal surgical intervention and a very good prognosis.”
Destounis explained the ACR’s recommendations emphasize communication between providers and patients and highlight improving screening disparities that currently exist in underrepresented populations.
According to the American Cancer Society, although Black women have a 4% lower incidence rate of breast cancer than white women, they have the lowest 5-year relative breast cancer survival rate compared with all other racial and ethnic groups in every stage of diagnosis and for every breast cancer subtype.
ACR also noted that Black women are less likely to be diagnosed with stage I breast cancer and twice as likely to die of early breast cancers compared with non-Hispanic white women, which was among the factors that led to the ACR’s reclassification of Black women to high risk.
“They tend to have more aggressive tumors that are triple-negative. They tend to present at a later stage,” Destounis said. “So those are the women we need to reach and educate, and they need to undergo a risk assessment evaluation with their health care providers by age 25.”
References:
- Breast cancer death rates are highest for Black women — again. https://www.cancer.org/research/acs-research-news/breast-cancer-death-rates-are-highest-for-black-women-again.html. Published Oct. 3, 2022. Accessed May 10, 2023.
- Breast cancer screening in women at higher-than-average risk: Recommendations from the ACR. https://www.acr.org/Advocacy-and-Economics/ACR-Position-Statements/Breast-Cancer-Screening-in-Women-at-Higher-Than-Average-Risk. Published Feb. 15, 2018. Accessed May 10, 2023.
- Breast cancer screening for women at higher-than-average risk: Updated recommendations from the ACR. https://www.jacr.org/pb-assets/Health%20Advance/journals/jacr/Monticciolo_ACRHiRiskScr-1683132562870.pdf Published May 3, 2023. Accessed May 10, 2023.
- New ACR breast cancer screening guidelines call for earlier and more-intensive screening for high-risk women. https://www.acr.org/Media-Center/ACR-News-Releases/2023/New-ACR-Breast-Cancer-Screening-Guidelines-call-for-earlier-screening-for-high-risk-women. Published May 3, 2023. Accessed May 10, 2023.
Perspective
Back to Top
The new guidance issued by the American College of Radiology regarding breast cancer risk assessment in women by age 25 is welcome news. There are many women who are unaware that they are at higher-than-average risk for developing breast cancer and are therefore not undergoing more intense screening that could diagnose breast cancer at an earlier, more treatable stage. Although the guidelines pertain to all women, the ACR specifically mentions Black and Ashkenazi Jewish women. Black women are less likely to be diagnosed with breast cancer than women of other races but are more likely to die from breast cancer once they do receive a diagnosis of breast cancer. So, identifying Black women with a higher-than-average risk for developing breast cancer may help to make the diagnosis earlier through more intensive screening, provide more treatment options and decrease the disparity in breast cancer mortality. Ashkenazi women have a higher prevalence of genetic variants (such as those in the BRCA genes) that put them at risk for developing breast cancer, so targeted assessment will help identify these women at a younger age and offer the opportunity for earlier, more comprehensive screening options.
The integration of tools for risk assessment into primary care and OB/GYN practices and community outreach programs are going to be important in providing this assessment and identifying patients who may qualify for screening earlier than age 40.
Identifying women at high risk for breast cancer at a younger age than they or their physicians would typically consider initiating breast cancer screening means that screening options, including breast MRI, will be available to them prior to age 40. Giving patients the opportunity to learn about their personal risk early in life arms them with important information necessary to make informed health care choices. For example, some patients, upon learning that they are high risk for breast cancer, may choose to take medication aimed at reducing their risk, and others may pursue risk reducing mastectomy. It will be imperative that patients who are identified as high risk are referred to clinicians who specialize in the care of high-risk patients in order to discuss the risks and benefits of more intense screening and other risk-reducing strategies. The biggest advantage, as mentioned above, is the opportunity to diagnose breast cancer at an earlier, more treatable stage among women at higher risk for breast cancer. One con to screening for more premenopausal women is that their breasts are typically denser and more active, so screening can pick up benign findings that may lead to biopsies or surgical procedures for findings unrelated to cancer.
Collapse
Breast cancer screening for women at higher-than-average risk: Updated recommendations from the ACR. https://www.jacr.org/pb-assets/Health%20Advance/journals/jacr/Monticciolo_ACRHiRiskScr-1683132562870.pdf. Published May 3, 2023. Accessed May 10, 2023.
Click Here to Manage Email Alerts