Original article
Health services research and policy
Breast Cancer Screening for Average-Risk Women: Recommendations From the ACR Commission on Breast Imaging

https://doi.org/10.1016/j.jacr.2017.06.001Get rights and content

Abstract

Breast cancer is the most common non-skin cancer and the second leading cause of cancer death for women in the United States. Before the introduction of widespread mammographic screening in the mid-1980s, the death rate from breast cancer in the US had remained unchanged for more than 4 decades. Since 1990, the death rate has declined by at least 38%. Much of this change is attributed to early detection with mammography. ACR breast cancer screening experts have reviewed data from RCTs, observational studies, US screening data, and other peer-reviewed literature to update our recommendations. Mammography screening has consistently been shown to significantly reduce breast cancer mortality over a variety of study designs. The ACR recommends annual mammography screening starting at age 40 for women of average risk of developing breast cancer. Our recommendation is based on maximizing proven benefits, which include a substantial reduction in breast cancer mortality afforded by regular screening and improved treatment options for those diagnosed with breast cancer. The risks associated with mammography screening are also considered to assist women in making an informed choice.

Introduction

Breast cancer is the most common nonskin cancer and the second leading cause of cancer death for women in the United States. One in eight women can expect to develop breast cancer over her lifetime. For 2017, we expect approximately 255,180 new invasive breast cancer cases, 63,410 in situ cancers, and 40,610 breast cancer deaths in women nationwide [1].

Before the introduction of widespread mammographic screening in the mid-1980s, the death rate from breast cancer in the United States had remained unchanged for more than 4 decades. Since 1990, the death rate has steadily declined by at least 38% through 2014 [2,3]. Although therapies have improved, screening has had a greater impact on mortality reduction [4-7]. Since our last update [8], advances in mammography have occurred nationally. Digital mammography has virtually replaced film-screen, and digital breast tomosynthesis (DBT) is becoming widely available. Although no new randomized controlled trials (RCT) have been reported, there is robust new evidence from observational studies.

ACR breast cancer screening experts have reviewed data from RCTs, observational studies, US screening data, and other peer-reviewed literature. Our analysis includes consideration of the ACR Appropriateness Criteria (AC), which use robust strength-of-evidence methodology to create breast cancer screening appropriateness criteria, as accepted by the National Guidelines Clearinghouse [9]. This document involves recommendations for women of average risk for breast cancer. High-risk populations will be considered in a separate report.

Section snippets

Mammographic Screening

For average-risk women, mammography is the main modality for the early detection of breast cancer. The ACR recommends annual mammographic screening starting at age 40. Our recommendation is based on maximizing proven benefits, which include a substantial reduction in breast cancer mortality afforded by regular screening. The risks associated with mammographic screening also are considered to assist women in making an informed choice.

Discussion

The ACR recommendation of annual mammographic screening beginning at age 40 is strongly supported by evidence from a variety of sources and seeks to maximize the benefits afforded by regular screening. The most current evidence suggests that a reduction in breast cancer mortality of approximately 40% can be achieved among women who undergo regular mammography [22,38]. The risks of screening are important and should be conveyed to women as they consider their options. The most common risk is

Take-Home Points

  • Regular mammographic screening results in a substantial reduction in breast cancer mortality across multiple study designs.

  • The ACR recommends annual mammographic screening beginning at age 40 for women at average risk for developing breast cancer.

  • The age to stop screening should be based on each woman’s health status rather than an age-based determination.

  • These ACR recommendations allow women to obtain the maximum life-extending benefits and provide improved treatment options for those

References (0)

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Dr Hendrick is a consultant for GE Healthcare. Dr Helvie has received an institutional grant (tomosynthesis) from GE Healthcare. Dr Eby is a consultant for Leica Biosystems. All other authors have no conflicts of interest related to the material discussed in this article.

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