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While the typical recommendation is for women to start getting mammograms at age 40, the American College of Radiology has released new guidelines that call for all women to have a breast cancer risk assessment by age 25 to determine if they should start screening mammograms before they turn 40.
This early step is particularly important for women who are Black or Ashkenazi Jewish, the guideline authors said.
Woman who have higher risks because of their genes, such as those who carry the BRCA1 gene mutation, as well as women exposed to chest radiation at a young age and those with a calculated lifetime breast cancer risk of 20% or more should begin having MRI screening started at ages 25 to 30, the American College of Radiology (ACR) now recommends. These women should start having an annual mammogram at ages 25 to 40, depending on their specific risk.
“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,” said guidelines corresponding author Dr. Debra Monticciolo, division chief of breast imaging at Massachusetts General Hospital in Boston.
“These evidence-based updates should spur more informed doctor-patient conversations and help providers save more lives,” she said in an ACR news release.
The ACR also recommended that women who were diagnosed with breast cancer before age 50 and those who have a personal breast cancer history and dense breasts should have a supplemental breast MRI each year. Those who can't undergo MRI should instead have contrast-enhanced mammography (CEM).
For average-risk women, the ACR recommends continuing annual screening starting at age 40.
The U.S. breast cancer death rate dropped 43% since mammography became widespread in the 1980s, according to U.S. National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) data. The rate had not changed in the previous 50 years. Breast cancer rates, meanwhile, have not changed for men, who undergo the same treatment as women but without regular screening.
The reasons for urging Black and other minority women to screen earlier include that, prior to age 50, minority women are 127% more likely to die of breast cancer than white women. They are also 72% more likely to be diagnosed with breast cancer and 58% more likely to be diagnosed with advanced breast cancer.
Even with roughly equal incidence rates, Black women are still 42% more likely to die from breast cancer, less likely to be diagnosed while at stage 1 but still twice as likely to die of early breast cancers.
Black women also have a twofold higher risk of aggressive -- “triple-negative” -- breast tumors and a higher risk of BRCA1 and BRCA2 genetic mutations.
“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,” said guidelines co-author Dr. Stamatia Destounis, chair of the American College of Radiology Breast Imaging Commission and managing partner at Elizabeth Wende Breast Care in Rochester, N.Y.
“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," Destounis said in the release.
The new ACR guidelines were published online May 3 in the Journal of the American College of Radiology.
The U.S. Centers for Disease Control and Prevention has more on breast cancer screening.
SOURCE: American College of Radiology, news release, May 3, 2023
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