BREAST CANCER SCREENINGE

New guidelines from the American Society of Breast Surgeons support yearly screening mammography for women at average risk of breast cancer beginning at age 40.

"Start with risk assessment," Dr. Pat Whitworth, co-chair of the panel that developed the new position statement, told Reuters Health by email. "Too many women with above-average risk are managed as if they have average risk by default, with great potential to miss the chance to detect cancer early or prevent it altogether."

Dr. Whitworth of Nashville Breast Center, in Tennessee, and colleagues on the panel summarized the available data to make recommendations on breast-cancer screening for women at both average and higher risk, as well as to make surveillance-imaging recommendations for women with a prior history of breast cancer. Their report was published May 3 on the group's website.

Risk assessment should begin at age 25 or when first seen by a breast physician or other appropriate healthcare provider, according to the panel. It should include assessment of family history of malignancies and determination of whether the woman has a history of atypical hyperplasia or lobular carcinoma in situ, or a history of chest or mantle radiation therapy between the ages of 10 and 30.

In any of these settings, the woman should be considered at higher risk of breast cancer and should follow higher-risk screening recommendations.

Women with average risk should have annual mammography (preferably 3D mammography) beginning at age 40, and, if they have increased breast density, supplemental imaging should be considered, the panel advises.

Women with higher-than-average risk - including the risk factors listed above, or greater than 20% estimated lifetime risk of breast cancer based on risk assessment models - should have annual MRI starting at age 25 or annual 3D screening mammography starting at age 30 and should have access to supplemental imaging with an additional modality (preferably MRI) starting at age 35 when recommended by their physicians.

Women with non-dense breasts and a history of breast cancer at age 50 or older should undergo annual mammography (preferably 3D mammography), the panels recommends. Those with a history of breast cancer before age 50 or with dense breasts should also have access to annual supplemental imaging (preferably MRI) when recommended by their physician. These recommendations apply to women who did not undergo bilateral mastectomy.

Other available guidelines suggest beginning routine mammography at different ages and/or with different frequencies. The U.S. Preventive Services Task Force recommends biennial screening of average-risk women beginning at age 50 and continuing through age 74, but it supports an individualized approach weighing benefits and false-positive risks for women between 40 and 50 years of age.

The American Cancer Society recommends annual screening for average-risk women age 45 to 54 years and biennial screening for average-risk women age 55 and older, with screening to continue as long as the life expectancy is 10 years or longer.

The American College of Radiology and Society for Breast Imaging jointly recommend annual mammographic screening beginning at age 40 for average-risk women and earlier for higher-risk women, who should also have supplemental screening with contrast-enhanced breast MRI.

"Everyone agrees that the most life-years saved obtain if screening starts at 40, even those who recommend starting later," Dr. Whitworth said. "Their objections are based on anxiety and negative biopsies and overdiagnosis (finding a cancer that would not harm the patient in her lifetime)."

"Do risk assessment before recommending and discussing a screening plan for your individual patient," she advised.

SOURCE: https://bit.ly/2WkuH4U