New Guidelines Suggest Earlier Breast Cancer Screening for Some Women

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A study out of Boston suggested that up to 50% of all women between ages 40 and 44 may have an elevated breast cancer risk, qualifying them to begin cancer screenings earlier than the new recommended age of 45.2

Researchers reviewed a database of patient-reported risk factors and family history for all women entering the specialty breast practice at Massachusetts General Hospital from March 2011 to October 2015. Patients with a breast cancer history were excluded. In the cohort of 909 qualifying women, 39% met the American Cancer Society (ACS) criteria for above average risk, and an additional 11% met the added ASBrS guidelines for elevated lifetime risk.

“Oncologists need to understand the necessity of risk assessment in determining who needs mammography at a younger age,” said senior study author Kevin Hughes, MD, co-director of the Avon Comprehensive Breast Evaluation Center at Massachusetts General Hospital and associate professor of surgery at Harvard Medical School in Boston. “Oncologists will be asked to weigh in on the new screening guidelines promulgated by the American Cancer Society, and they need to emphasize to their health systems that cancer risk assessment is an essential part of the guidelines.”

He told Cancer Therapy Advisor that the number of women found to have above-average risk between ages 40 and 44 was extremely surprising, suggesting a formal risk assessment by a qualified physician is crucial before a physician recommends delaying regular screening mammography until age 45. However, Dr Hughes said few women undergo risk assessment because it can be complex and time-consuming.

Last year, the ACS raised its recommended age for beginning regular mammographic screenings from 40 to 45. However, for women who are considered at above-average risk based on a risk assessment, have a confirmed or suspected genetic mutation, or have had thoracic radiotherapy at a young age, the recommendation is to begin screenings at age 40.

The ASBrS similarly revised its guidelines to delay regular screening, with the added recommendation of earlier exams for women whose lifetime breast cancer risk is specifically 15% to 20% based on a risk assessment. Recommended screening procedures for women with elevated risk include annual mammography, annual mammography combined with magnetic resonance imaging (MRI), and genetic testing.

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In this study, 6964 women age 40 and older who did not have a breast cancer diagnosis were seen as new patients in the breast clinic, and 909 (13%) were between the ages 40 to 44. Among this 13%, risk assessment identified 352 women (39%) deemed at above-average risk by the ACS criteria and an additional 103 (11%) by the ASBrS guidelines who were eligible to start screening mammography at age 40. In addition, 59 women (6.5%) were found to be at risk for a suspected genetic mutation, 127 women (13.8%) qualified for screening MRI, and 166 women (18.3%) qualified for both genetic testing and screening MRI.

“It is critical to identify women who need genetic testing, MRI, and mammography in order to save lives and to decrease the morbidity of cancer treatment,” Dr Hughes told Cancer Therapy Advisor.