This article reports on the latest breast cancer screening recommendations from two important radiology professional organizations: the American College of Radiology (ACR) and the Society of Breast Imaging (SBI). The recommendations were published in the January 2010 issue of The Journal of the American College of Radiology.
The recommendations say:
These recommendations are much the same as current breast cancer screening recommendations, but are different from guideline changes recommended by the U.S. Preventive Services Task Force in November 2009. The task force recommended:
These recommended changes sparked intense discussion and debate. Still, the good news is that most medical professionals and policy experts rejected the changes. Breastcancer.org salutes the ACR and SBI for objecting to any changes to current breast cancer screening guidelines.
Like many in the Breastcancer.org community, you may have questions about the debate triggered by the task force recommendations. Breastcancer.org offers information about the recommendations, including how they came about, how they might influence screening in the future, and what they mean for women today.
Annual screening mammography should begin at age 40 and even earlier for women at high risk for breast cancer, according to recommendations from the American College of Radiology (ACR) and the Society of Breast Imaging (SBI).
Average-risk women should begin annual breast cancer screening at age 40, and higher-risk women should begin by age 30, but no sooner than 25, the ACR and SBI recommend in guidelines published in the January issue of the Journal of the American College of Radiology.
"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.
"The significant decrease in breast cancer mortality, which amounts to nearly 30% since 1990, is a major medical success and is due largely to earlier detection of breast cancer through mammography screening," added Lee, of Memorial Sloan-Kettering Cancer Center in New York.
The recommendations conflict with those issued late last year by the U.S. Preventive Services Task Force (USPSTF), which suggested that routine screening begin at age 50. The task force also recommended screening every other year, not annually. The task force recommended that women under 50 talk to their healthcare providers about the pros and cons of screening mammography.
The task force recommendations touched off a war of words between supporters and opponents, including the ACR, which asserted that "two decades of decline in breast cancer mortality could be reversed, and countless American women may die needlessly from breast cancer each year" if the recommendations were followed.
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.
They say carriers of BRCA mutations 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.
The guidelines state that breast ultrasound might be considered, in addition to mammography, for high-risk women and those with dense breast tissue that is often difficult to assess by conventional mammography.
Political fallout from the USPSTF recommendations -- which galvanized the breast cancer lobby and medical imaging industry in opposition to the change -- has already rendered much of the scientific debate meaningless.
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."
In its debate on healthcare reform legislation, the Senate went a step further and essentially overruled the task force by approving an amendment that would mandate insurance coverage of mammography for women ages 40 to 49.
Moreover, the Senate approved an amendment to the amendment, making the task force's 2002 recommendation -- which suggested that annual mammography begin at age 40 -- the operative standard.
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