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New SBI and ACR recommendations - breast cancer screening should begin at age 40

Author: Tamer M. Fouad, M.D. | Submitted: January 04, 2010. Updated: January 04, 2010.

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The new recommendations from the Society of Breast Imaging (SBI) and the American College of Radiology (ACR) on breast cancer screening, published in the January issue of the Journal of the American College of Radiology, state that breast cancer screening should begin at age 40 and earlier in high-risk patients. The recommendations also suggest appropriate utilization of medical imaging modalities such as mammography, magnetic resonance imaging, and ultrasound for breast cancer screening.

The recent success in cause specific mortality since the 1990’s is mainly attributed to nationwide screening mammographies. While all major North American organizations recommend screening mammography for women more than 50 years old, some controversy remained regarding the strength of evidence supporting screening women between the ages of 40 to 50 years.

Organizations supporting screening mammography beginning at 40 years include:
The American Medical Association (AMA)
The American College of Obstetricians and Gynecologists (ACOG)
The American College of Radiology (ACR)
The American Cancer Society (ACS)

Organizations supporting screening should start at 50 years include:
The USPSTF
Canadian Task Force on Preventive Health Care (CTFPHC)
The American Academy of Family Physicians (AAFP)
The American College of Preventive Medicine (ACPM)

AAFP and ACPM recommend that mammography in high-risk women begin at age 40, and AAFP recommends that all women aged 40-49 be counseled about the risks and benefits of mammography before making decisions about screening.

The new recommendations released by the SBI and ACR include recommendations for imaging screening for breast cancer by imaging technique (mammography, MRI, and ultrasound) and by risk factor. The recommendations state that the average patient should begin annual breast cancer screening at age 40. High-risk patients should begin by age 30 but not before 25. “Evidence to support the recommendation for regular periodic screening mammography comes from the results of several randomized trials (RCTs) conducted in Europe and North America that included a total of nearly 500,000 women. Overall, based on a meta-analysis of the RCTs, there was a 26 percent reduction in mortality,” said Lee.

“It should be remembered that mammography is the only imaging modality that has been proven to decrease mortality from breast cancer. However major efforts continue to build on this success by developing additional methods to screen for early breast cancer,” she said.

“The SBI and ACR wish to remind women and their physicians that in those instances in which there is a concern that risk of developing cancer is considerably elevated from that of the general population, consultation with appropriate experts in breast cancer genetics and/or high risk management is desirable,” said Lee.

CITE THIS ARTICLE:
Tamer M. Fouad, M.D.. New SBI and ACR recommendations - breast cancer screening should begin at age 40. Doctors Lounge Website. Available at: http://www.doctorslounge.com/index.php/blogs/page/313. Accessed October 21 2014.

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