Breast Cancer Screening for Women at Higher-Than-Average Risk: Updated Recommendations From the ACR
- Study type
- Clinical guideline
- Study name
- ACR 2023
- Design
- Recommendations (clinical guideline) of the American College of Radiology (ACR)
- Source
- Journal of the American College of Radiology · 2023
In plain words
This guide says that women whose risk of breast cancer is higher than usual (for example because of a gene change, radiotherapy to the chest at a young age, or a personal history of breast cancer) should start screening earlier and be checked more closely. For most of these women, a breast MRI is recommended in addition to a mammogram. It is best for every woman to review her risk with a doctor by the age of 25, so that the right screening plan can be set for her.
Key points
Key guideline recommendations
Annual screening from age 40 is recommended for women at average risk, and earlier and/or more intensive screening for women at higher-than-average risk.
For most women at higher-than-average risk, the supplemental screening method of choice is breast MRI.
Women at increased genetic risk, women with a calculated lifetime risk of 20% or more and women exposed to chest irradiation at a young age should have MRI surveillance starting at age 25 to 30 and annual mammography (with a starting age varying between 25 and 40 depending on the type of risk).
Mutation carriers can delay screening mammography until age 40 if annual screening breast MRI is performed as recommended.
Women diagnosed with breast cancer before age 50 or with a personal history of breast cancer and dense breasts should have annual supplemental breast MRI.
Other people with a personal history of breast cancer and those with atypia on biopsy should strongly consider MRI screening, especially if other risk factors are present.
For women with dense breasts who want supplemental screening, breast MRI is recommended. For those who qualify for MRI but cannot have it, contrast-enhanced mammography or ultrasound can be considered.
All women should have a risk assessment by age 25, especially Black women and women of Ashkenazi Jewish descent, so that women at higher-than-average risk are identified and appropriate screening is started.
Study population
Women at higher-than-average risk of breast cancer, including: women at increased genetic risk (mutation carriers), women with a calculated lifetime risk of 20% or more, women with chest irradiation at a young age, women diagnosed with breast cancer before age 50 or with a personal history of breast cancer and dense breast tissue, women with atypia on biopsy, and women with dense breast tissue who want supplemental screening.
Endpoints
This document is a set of recommendations and has no trial endpoint. The abstract presents screening recommendations for different high-risk groups.
Safety and side effects
The abstract does not mention the possible harms of screening methods (such as false-positive results). Details are in the full text of the paper.
Clinical significance and place in guidelines
These ACR recommendations provide a framework for deciding when to start and how to screen women at high risk. Their core is breast MRI as the supplemental method of choice and risk assessment by age 25. Their concordance with other guidelines should be checked separately, and the final decision for each patient rests with the treating physician.
Limitations
The abstract does not report the level of evidence or grade of the recommendations, or the methodology of guideline development. These should be checked in the full text of the paper. For the same reason, no level of evidence is given in the recommendations table.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.