May 5, 2023 — The American College of Radiology (ACR) has released updated breast cancer screening guidelines that underscore the need for early risk assessment — especially among Black and Ashkenazi Jewish women.
The guidance calls for all women — but these subgroups in particular — to undergo a breast cancer risk workup by the age of 25. The recommendation was published May 3 in the Journal of the American College of Radiology. The guidance also reiterates that annual breast cancer screening should begin at age 40 for women at average risk of the disease.
Why the focus on Black women in particular and women of color in general getting early screening? The ACR listed the following reasons:
- Prior to age 50, women of color 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 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 cancers.
- Black women have a two-fold higher risk of aggressive — “triple-negative” — breast tumors and a higher risk of BRCA1 and BRCA2 genetic mutations.
“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 of Massachusetts General Hospital in Boston and co-founder and lead of the ACR’s Screening Leadership Group, said in a statement released by the college. “These evidence-based updates should spur more-informed doctor-patient conversations and help providers save more lives.”
The ACR also added the following updates to the guideline:
- 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 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 MRI.
- High-risk women who desire supplemental screening — but cannot undergo MRI screening — should consider contrast-enhanced mammography.
National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) data show that since mammography screening was implemented in the U.S. in the 1980s, the breast cancer death rate in women dropped 43%, the ACR noted.