The American College of Radiology (ACR) and the Society of Breast Imaging (SBI) on June 18 released updated screening mammography guidance in the Journal of the American College of Radiology -- once again stressing the importance of annual exams starting at age 40.
Overall, the guidance is similar to the ACR's 2017 recommendation, but it now includes language that specifically addresses women of color, lead author Dr. Debra Monticciolo of Baylor Scott & White Healthcare in Temple, TX, told AuntMinnie.com via email.
"We updated the guideline because there is new and continuing support for our recommendation for annual screening starting at age 40," she said. "We also wanted to be more inclusive, recognizing that older literature did not optimally include women of color."
The guidance recommends annual screening mammography beginning at age 40 and continuing past age 74, "unless severe comorbidities limit life expectancy," the team wrote. It stresses that "regular screening makes a real and significant mortality difference," according to Monticciolo, and that "chemotherapy is much more effective in screened women versus unscreened women."
"Using similar [chemotherapy] treatments, mortality from breast cancer is reduced over 40% in screened women ... and advanced cancers are significantly reduced," she said. "This is hugely important and has not been previously reported in any guideline."
The authors acknowledge that frequent screening has its downsides, but its benefits are worth it.
"Although recall and biopsy recommendations are higher with more frequent screening, so are life-years gained and breast cancer deaths averted," the group wrote. "Women who wish to maximize benefit will choose annual screening starting at age 40 years and will not stop screening prematurely."
Finally, the updated recommendation emphasizes the particular importance of early screening in women of color, who may have higher incidence of BRCA1 and BRCA2 mutations and "twice the incidence of aggressive, triple-negative breast cancers," according to the authors.
"Minority women are 72% more likely to be diagnosed with breast cancer before age 50, are 58% more likely to be diagnosed with advanced-stage disease under the age of 50, and are 127% more likely to die of breast cancer under age 50, as compared to non-Hispanic white women," Monticciolo told AuntMinnie.com. "This outlines the importance of screening starting at age 40, not waiting until 50. Waiting until age 50 to be screened is detrimental to all women, but disadvantages minority women in particular."
