Current Breast Cancer Screening Guidelines
American Cancer Society Screening Guidelines
A woman is considered high risk if her lifetime risk of breast cancer development is 20% or greater, according to risk assessment tools that are based mainly on family history and/or she has a:
known BRCA1 or BRCA2 gene mutation (based on having had genetic testing)
first-degree relative with a BRCA1 or BRCA2 gene mutation, and have not had genetic testing themselves
Had radiation therapy to the chest when they were between the ages of 10 and 30 years
Have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromes
Recommendation is as followed:
Breast MRI and a mammogram every year, typically starting at age 30.
Average Risk Women
A woman is considered to be at average risk if she doesn’t have a personal history of breast cancer, a strong family history of breast cancer, or a genetic mutation known to increase risk of breast cancer and has not had chest radiation therapy before the age of 30. A woman is considered average risk therefore if her lifetime risk of breast cancer development is < 12.5%.
Recommendations are as follows:
Women between 40 and 44 have the option to start screening with a mammogram every year.
Women 45 to 54 should get mammograms every year.
Women 55 and older can switch to a mammogram every other year, or they can choose to continue yearly mammograms.
Screening should continue as long as a woman is in good health and is expected to live at least 10 more years.
High Risk Women
Current Breast Cancer Screening Guidelines for women with Dense Breast
What about women with Dense Breast….
They have elevated risks!
Risk Factor assessment tools not only needs to encompass family history but BREAST DENSITY as well.
That is why the Tyrer-Cuzick model is recommended as a more thorough assessment stratification tool.
Women with intermediate 12.6 % -19% lifetime risk of breast cancer and those with Dense Breast Tissue??
This is where screening guidelines are even more vague.
Yet there is significant research now that shows these women need to undergo supplemental imaging in addition to mammogram.
It is strongly suggested that those women should undergo whole breast ultrasound, Fast MRI, contrast enhanced mammography, or MBI.
Research on Breast Density and Breast Cancer Screening.
M. Covington. Estimate of the Number of Breast Cancers Undetected by Screening Mammography in Individuals with Dense Breast Tissue. Archives of Breast Cancer. August 2022.
Key findings: Assuming an ICDR of 16 cancers beyond mammography per 1,000 individuals with dense breast tissue, 38.8 million mammograms in the U.S. in 2021, and a prevalence of dense breast tissue of 43%, the number of cancers undetected by mammography in individuals with dense breast tissue participating in screening in the U.S. is estimated at 267,000.
Reboljl et al. Addition of ultrasound to mammography in the case of dense breast tissue: systematic review and meta-analysis. British Journal of Cancer. (2018) 118:1559–1570
Key findings: The proportion of total cancers detected only by ultrasound was 0.29 (95% CI: 0.27–0.31), consistent with an approximately 40% increase in the detection of cancers compared to mammography. In the studied populations, this translated into an additional 3.8 (95% CI: 3.4–4.2) screen-detected cases per 1000 mammography-negative women. In conclusion, Studies have consistently shown an increased detection of breast cancer by supplementary ultrasound screening. An inclusion of supplementary ultrasound into routine screening will need to consider the availability of ultrasound and diagnostic assessment capacities.
Harada-Shoji N et al. Evaluation of Adjunctive Ultrasonography for Breast Cancer Detection Among Women Aged 40-49 Years With Varying Breast Density Undergoing Screening Mammography A Secondary Analysis of a Randomized Clinical Trial. Oncology. 2021. JAMA Network Open. 2021;4(8)
Key findings: In this secondary analysis of a randomized clinical trial, screening mammography alone demonstrated low sensitivity, whereas adjunctive ultrasonography was associated with increased sensitivity. These findings suggest that adjunctive ultrasonography has the potential to improve detection of early-stage and invasive cancers across both dense and nondense breasts. Supplemental ultrasonography should be considered as an appropriate imaging modality for breast cancer screening in asymptomatic women aged 40 to 49 years regardless of breast density.
Monticciolo D et al. Breast Cancer Screening in Women at Higher-Than-Average Risk: Recommendations From the American College of Radiology. Journal of American College of Radiology. 2018;15:408-414
Key findings: Early detection decreases breast cancer mortality. The ACR recommends annual mammographic screening beginning at age 40 for women of average risk. Higher-risk women should start mammographic screening earlier and may benefit from supplemental screening modalities. Breast MRI is also recommended for women with personal histories of breast cancer and dense tissue, or those diagnosed by age 50. Ultrasound can be considered for those who qualify for but cannot undergo MRI. All women, especially black women and those of Ashkenazi Jewish descent, should be evaluated for breast cancer risk no later than age 30, so that those at higher risk can be identified and can benefit from supplemental screening.
Buchberger W et al. Combined screening with mammography and ultrasound in a population based screening program. European Journal of Radiology. 2018. (101)24–29
Key findings: The overall sensitivity of mammography only was 61.5% in women with dense breasts and 86.6% in women with non-dense breasts. The sensitivity of mammography plus ultrasound combined was 81.3% in women with dense breasts and 95.0% in women with non-dense breasts. Supplemental ultrasound improves cancer detection in screening of women at average risk for breast cancer. Recall rates and biopsy rates can be kept within acceptable limits.