"Our recommendations for women in the higher-risk population are based on the latest data available regarding the use of MRI, ultrasound, molecular breast imaging (MBI), and digital breast tomosynthesis (DBT) in addition to digital mammography (DM)," wrote lead author Debra L. Monticciolo, MD from the Scott & White Medical Center at Texas A&M University in Temple, and colleagues.
Genetic predisposition, a history of receiving chest or mantle radiation therapy at a young age, lobular neoplasia, ethnicity, age, family history, breast density, hormonal and reproductive history, or a previous diagnosis of breast cancer can attribute to a woman being at a "higher-than-average" risk. The earlier the detection and diagnosis, the better. And there are different ways women identified as high risk should go about receiving breast cancer screenings, as the ACR suggests.
The following takeaways include:
- Women of African and Ashkenazi Jewish descent should be screened for breast cancer no later than age 30.
- A DM with or without DBT should be performed once a year beginning at 30 for women with a genetics-based increased risk or a calculated life-time risk of 20 percent or more.
- Women who carry the BRCA1 gene can delay getting mammograms until they are 40 years old, but only if they are imaged annually with a contrast-enhanced breast MRI starting at 25 years of age.
- Women who've had mantle or chest radiation therapy who received "a cumulative dose of 10 Gy or more before the age of 30, DM, with or without DBT, should be performed annually beginning at age 25 or 8 years after radiation therapy."
- Women diagnosed with breast cancer, ADH or lobular neoplasia before age 40, should receive annual screenings once diagnosed.
- Women with personal histories of breast cancer and dense breast tissue or those diagnosed before age 50 should receive annual breast MRI surveillance exams.
- Women who quality for but cannot undergo a breast MRI or who are at a high risk limited to increase breast density should consider an ultrasound exam.
- An MBI (molecular breast imaging) exam isn't recommended for women at a high-risk for developing breast cancer.