ACR's Screening Mammogram Recommendations

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The American College of Radiology (ACR) and the Society of Breast Imaging (SBI) have published their guidelines for screening mammography in the January issue of the Journal of the American College of Radiology. Their recommendations for breast cancer mammography screening do not agree with the US Preventive Services Task Force.

You may recall, in November 2009, the US Preventive Services Task Force released new recommendations on screening mammography, in which they recommended against routine mammogram screening in women under age 50, and recommended that mammograms now be every two years in women ages 50-74. The USPSTF later clarified their recommendations stating the decision to start regular, biennial screening mammography before the age of 50 years should be an individual one. Women younger than 50 should discuss their individual needs, benefits, and harms with their doctors and decide for themselves.

ACR and SBI recommends screening mammography should begin at age 40 for women with average-risk of breast cancer. Women at higher-risk should begin by age 30, but no sooner than 25.

Women at high risk include carriers of BRCA mutations. Women and their doctors can use assessment tools to calculate individual risk for breast cancer. The most commonly used risk assessment tool is the Gail Model which can give your individual risk of being diagnosed with breast cancer in the next 5 years.

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In addition to the recommendations related to age and screening intervals, the ACR-SBI guidelines integrate use of breast MRI and ultrasound into the screening algorithm.

Women at high risk should begin annual breast MRI evaluations by age 30. Women who have at least a 20% lifetime risk of breast cancer, on the basis of family history, also should begin annual breast MRI by age 30, in addition to annual mammography.

Breast ultrasound is often used in addition to mammography for high-risk women and those with dense breast tissue that is often difficult to assess by conventional mammography.

"Evidence to support the recommendation for regular periodic screening mammography comes from the results of several randomized trials conducted in Europe and North American that included a total of nearly 500,000 women," Carol H. Lee, MD, chair of the ACR Breast Imaging Commission, said in a statement.

In a prepared statement, HHS Secretary Kathleen Sebelius pointed out that the task force does not set health policy, and she encouraged women to "keep doing what you have been doing for years -- talk to your doctor about your individual history, ask questions, and make the decision that is right for you."

Breast cancer causes about 4,500 deaths annually in women ages 40-49, and is one of the leading causes of death in women in this age group.

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Comments

1) Calcifications in the breast classified by Mammo. as BI RAD III are they malignant or benign. 2) In this case, is it acceptable to observe these calcifications by mammogram, and for how long. 3) A Fibroadenoma ( breast ) clinically and radiologically : what is the risk to be a cancer ? Is a clinical and ultrasound surveillance enough ? and what if the surgeon decides to go for excision biopsy, would it be a medical error ?