American Society of Breast Surgeons release mammography screening guidelines based on individual risk

The American Society of Breast Surgeons (ASBrS) has released new screening mammography guidelines based on a patient’s individual breast cancer risk profile—the first guidelines based on an individualized approach, according to ASBrS.

“These new recommendations were ASBrS member driven and developed based on their unique, firsthand perspective on the disease and patient journey. They represent a deep, passionate and scientifically-backed commitment to advocate for increased years of life over costs,” said Shawna Willey, MD, ASBrS chairman of the board, in a news release. “They also aim to minimize breast cancer disparities across race and ethnicity through earlier disease detection for all.”

The guidelines—supported by the American College of Radiology (ACR)—recommend all women undergo formal risk assessment by the age of 25.

In women with average risk, the ASBrS suggest annual screening start at age 40. For those with increased likelihood of developing cancer, such as a family history of the disease or certain pathogenic mutations, recommendations suggest a range of comprehensive screening strategies based on individual risk factors. 

A comprehensive strategy for women with a predicted lifetime risk of ≥ 20% includes mammography coupled with access to MRI beginning at 35 years old. Patients with genetic abnormalities should follow similar guidelines, beginning at age 25, according to the new guidelines.

The ASBrS guidelines differ from the most current recommendations from the United States Preventive Services Task Force (USPSTF) and American Cancer Society which suggest women at average risk undergo biennial screening beginning at age 50. The USPSTF also suggests women between 40 and 50 receive an individualized approach that take into account the risk of false-positives.

“Routine screening for women age 40 to 49 has been unequivocally demonstrated to reduce mortality by 15%,” said Walton A. Taylor, MD, ASBrS president and Texas Health Physicians Group, Dallas, in the same release. “However, today USPSTF guidelines delay annual screening until age 50 because they are based on an efficiency statistical model that also considers the impact of potential screening risks.

“In addition to elevated costs, these include a statistical probability of false negative and positive results leading to unnecessary anxiety and additional medical procedures, overdiagnosis of indolent cancers and increased radiation exposure.”

The newly issued guidelines also suggest screening incorporate a detailed stratification of risk, take into account breast cancer sub-types more prevalent in specific racial and ethnic groups. 

“The ACR supports the American Society of Breast Surgeons (ASBrS) recommendations that women start getting annual mammograms at age 40,” said Dana Smetherman, MD, chair of the ACR Commission on Breast Imaging. “We are pleased that ASBrS has reaffirmed their support for this most sensible approach,” said Dana Smetherman, MD, chair of the American College of Radiology Commission on Breast Imaging.”

The full recommendations can be read here