Know Your Risks: New Breast Cancer Screening Recommendations

In a nod toward the importance of early detection for decreasing breast cancer death, the American College of Radiology (ACR) has issued new breast cancer screening recommendations for high-risk women.

The new ACR guidelines for high-risk women, published online May 3 in the Journal of the American College of Radiology (JACR), now call for all women — particularly Black and Ashkenazi Jewish women — to have risk assessment by age 25 to determine if screening earlier than age 40 is needed.

Diana McInerney, director of the Lee Health Breast Centers, talks about the importance of annual breast mammograms and how the new guidelines may affect you.

The ACR continues to recommend annual screening starting at age 40 for women of average risk but now recommends “earlier and more intensive screening” for high-risk patients.

Diana explains that for screening purposes, a woman is considered at average risk for developing breast cancer if she doesn’t have:

• a personal history of breast cancer
• a strong family history of breast cancer, high-risk predisposition syndromes or genetic mutations
• a history of thoracic radiation therapy before the age of 30 years

“The American College of Radiology recommends all women of average lifetime risk (13%-15%) for breast cancer begin getting mammograms at age 40 — every year. It’s important to stress these women are of average risk, and these recommendations don’t include all women,” Diana notes.

What if you’re a woman with higher-than-average risk factors?

“The ACR encourages all women to talk with their healthcare providers about evaluating their risk of breast cancer by age 25 to determine if they need to be screened before age 40,” Diana says. “This is especially critical for Black and Ashkenazi Jewish descent women who are at higher risk of genetic mutations and for Black and other minority women who are at higher risk of breast cancer at younger ages.

“In other words, the ACR recommends women at higher-than-average risk start getting screened at an earlier age. Women at higher-than-average risk should, in general, start surveillance with digital mammography (DM) at an earlier age and consider supplemental screening as well, such as with magnetic resonance imaging (MRI).”

What factors might increase your risk?

Getting older. The risk for breast cancer increases with age. Most breast cancers are diagnosed after age 50.

Genetic mutations. Women who have inherited changes (mutations) to certain genes, such as BRCA1 and BRCA2, are at higher risk of breast and ovarian cancer.

Reproductive history. Starting menstrual periods before age 12 and starting menopause after age 55 expose women to hormones longer, raising their risk of getting breast cancer.

Having dense breasts. Dense breasts have more connective tissue than fatty tissue, which can sometimes make it hard to see tumors on a mammogram. Women with dense breasts are more likely to get breast cancer.

Personal history of breast cancer or certain non-cancerous breast diseases. Women who have had breast cancer are more likely to get breast cancer a second time. Some non-cancerous breast diseases, such as atypical ductal hyperplasia or lobular carcinoma in situ, are associated with a higher risk of getting breast cancer.

Family history of breast or ovarian cancer. A woman’s risk for breast cancer is higher if she has a mother, sister, or daughter (first-degree relative) or multiple family members on either her mother’s or father’s side of the family who has had breast or ovarian cancer. Having a first-degree male relative with breast cancer also raises a woman’s risk.

Previous treatment using radiation therapy. Women who had radiation therapy to the chest or breasts (for instance, treatment of Hodgkin’s lymphoma) before age 30 have a higher risk of getting breast cancer later in life.

SOURCE: Centers for Disease Control and Prevention

What factors led to the change in ACR recommendations for high-risk women?

The latest scientific evidence continues to point to earlier assessment as well as augmented and earlier-than-age-40 screening of many women — particularly Black women and other minority women, Dr. Debra Monticciolo, primary author of the new guidelines, said in a press release.

Factors that contributed to the ACR reclassification of Black women and other minorities to high-risk include that, compared to non-Hispanic white women:

• Prior to age 50, minority women are: 127% more likely to die of breast cancer; 72% more likely to be diagnosed with breast cancer; and 58% more likely to be diagnosed with advanced-stage breast cancer.
• Black women are 42% more likely to die from breast cancer despite roughly equal incidence rates.
• Black women are less likely to be diagnosed with stage I breast cancer but twice as likely to die of early breast cancer.
• Black women have a two-fold higher risk of aggressive — “triple-negative” — breast tumors and a higher risk of BRCA1 and BRCA2 genetic mutations (placing them at higher risk).

The ACR also updated these recommendations:

Women with genetics-based increased risk (including BRCA1 carriers), those with a calculated lifetime risk of 20% or more, and those exposed to chest radiation at a young age are recommended to have MRI surveillance starting at ages 25 to 30. These women should start annual mammography at ages 25 to 40, depending on the type of risk.

Women diagnosed with breast cancer prior to age 50 or with a personal history of breast cancer and dense breasts should have annual supplemental breast MRIs.

High-risk women who desire supplemental screening — but cannot undergo MRI screening — should consider contrast-enhanced mammography (CEM).

According to the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) data, since mammography became widespread in the 1980s, the U.S. breast cancer death rate in women, unchanged for the previous 50 years, has dropped 43%. Breast cancer deaths in men, who have the same treatment as women but are not screened, have not declined.

Don’t put off learning when you should begin routine mammogram testing, McEnerney cautions.

A recent report showed only about 65 percent of women above the age of 40 had a mammogram within the past two years, according to the Centers for Disease Control and Prevention.

Mammograms are essential, important, and potentially life-saving. Talk with your doctor about when to start mammography screening sooner than later.  

Use MyChart to schedule a screening today, or if you are not a MyChart user, call 239-236-4893 or sign up today.