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Breast Cancer Screening Guidelines and Supplemental Screening
Breast cancer is the most commonly diagnosed nonskin cancer and is the second leading cause of cancer death in women in the United States. For the year 2020, the American Cancer Society estimated 268,600 new cases of invasive breast cancer and over 41,000 deaths from breast cancer. Knowledge of screening guidelines and supplemental imaging tools will help you—the radiologist—communicate knowledgeably with patients and the referring providers about breast cancer screening strategies.
Breast Cancer Screening Guidelines
If breast cancer is diagnosed and treated when localized to the breast, the 5-year relative survival rate is 99%. However, 5-year relative survival drops to 27% when distant metastatic disease is present at the time of diagnosis. Mammographic screening results in early detection of breast cancer, and early detection of breast cancer saves lives. Multiple randomized control trials (RCTs), observational studies, and service screening studies have demonstrated that regular screening mammography decreases breast cancer mortality, as described in Chapter 12 .
Despite this, continued controversy and confusion persists in the media, public, and medical community with respect to screening mammography recommendations. Disagreement in mammography screening guidelines can be boiled down to three main disputed factors: (1) which published studies are analyzed and how that subset of data is interpreted; (2) what benefits and risks are incorporated; and (3) how the benefits and risks are weighed. Despite differences in screening mammography recommendations, annual screening mammography beginning at age 40 saves the most lives, confers the greatest reduction in breast cancer mortality, and results in the largest increase in life-years gained from screening. Please also refer to Chapter 12 for additional reading on screening mammography. This section will review and discuss the various guidelines pertaining to screening mammography.
Screening Guidelines for Average-Risk Women
In this section, we will review the screening mammography recommendations from various organizations, which are summarized in Fig. 11.1 .
ACR, SBI, ASBrS, NCCN, and NCBC
The American College of Radiology (ACR) recommends annual screening mammography for average-risk women beginning at age 40, with no specific age limit to stop screening as long as a woman is in good health. The American Society of Breast Surgeons (ASBrS), the National Comprehensive Cancer Network (NCCN), the National Consortium of Breast Centers (NCBC), and the Society of Breast Imaging (SBI) also recommend annual screening mammography beginning at age 40, for as long as a woman is healthy.
American Cancer Society
The American Cancer Society (ACS) guidelines recommend that average-risk women have the option to begin annual screening at 40 to 44 years (qualified recommendation), strongly recommend regular screening by age 45, and recommend cessation of screening if a woman’s life expectancy is less than 10 years. For screening intervals, the ACS strongly recommends annual mammography for women 45 to 54 years old, and either annual or biennial screening in women 55 years and older (qualified recommendation). The ACS acknowledges that there is a clear benefit to annual screening mammography beginning at age 40 but qualifies recommendations due to uncertainty about how each individual woman might balance the benefits and risks of screening.
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