Updated recommendations from the American College of Radiology encouraged all women—particularly Black women and Ashkenazi Jewish women—to undergo risk assessments at 25 years of age to determine whether they may need breast cancer screenings earlier than age 40, according to new guidelines published by Monticciolo et al in the Journal of the American College of Radiology.
Background
The American College of Radiology continues to recommend annual breast cancer screenings for average-risk women aged 40 years; however, earlier and more intensive screenings for high-risk patients may be needed.
Research Findings and New Screening Recommendations
Factors that contributed to the reclassification of Black women and other minorities as high risk included that, when compared with non-Hispanic White women:
- Prior to age 50, minority women may be 72% more likely to be diagnosed with breast cancer, 58% more likely to be diagnosed with advanced-stage breast cancer, and 127% more likely to die of the disease.
- Black women may be 42% more likely to die from breast cancer despite roughly equal incidence rates.
- Black women may be less likely to be diagnosed with stage I breast cancer but twice as likely to die of early-stage breast cancer.
- Black women have a twofold higher risk of developing triple-negative breast cancer and a higher risk of presenting with BRCA1 and BRCA2 genetic mutations.
“The latest scientific evidence continues to point to earlier assessment as well as augmented and earlier-than-age-40 screenings [for] many women—particularly Black women and other minority women,” emphasized lead guideline author Debra Monticciolo, MD, FACR, Chief of the Division of Breast Imaging and Co-Director of the Avon Comprehensive Breast Evaluation Center at Massachusetts General Hospital. “These evidence-based updates should spur more informed doctor-patient conversations and help providers save more lives,” she said.
Among the new breast cancer screening updates were:
- Women who have an increased risk of breast cancer as a result of genetics—including those with BRCA1 mutations—women with a calculated lifetime risk of 20% or more, and women exposed to chest radiation at a young age were advised to have magnetic resonance imaging (MRI) surveillance starting at age 25 to 30 years. These women were further encouraged to begin annual mammograms at age 25 to 40 years, depending on their individual risk type.
- Women diagnosed with breast cancer prior to age 50 years or those who have a personal history of breast cancer and dense breasts should undergo annual supplemental breast MRIs.
- High-risk women who want to undergo supplemental breast cancer screenings but are ineligible or otherwise unable to undergo MRI screenings should consider contrast-enhanced mammography.
Conclusions
“Since 1990, breast cancer death rates in Black women, who develop and die from the disease earlier, have only dropped approximately half as fast as in White women,” stressed senior guideline author Stamatia Destounis, MD, FACR, Chair of the Breast Imaging Commission and the Breast MRI Accreditation Committee at the American College of Radiology and a managing partner at Elizabeth Wende Breast Care. “We continue to regularly examine the latest evidence and update our recommendations to help save more Black women and others at high risk from this deadly disease,” she concluded.
Disclosure: For full disclosures of the guideline authors, visit jacr.org.
