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American Society of Breast Surgeons proposes new screening guidelines

by John W. Mitchell , Senior Correspondent
New screening mammography guidelines issued Friday by the American Society of Breast Surgeons (ASBrS) are based on individual patient risk profiles. The recommendations call for women to receive a formal risk assessment by age 25 and commence annual screenings at age 40.

“Our understanding of breast cancer risks and risk assessment has advanced,” Dr. Julie A. Margenthaler, professor of Surgery, Washington University School of Medicine and president-elect for ASBrS told HCB News. "We need to manage screening based on those risks, and they should be personalized in that way."

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The American College of Radiology (ACR) supports the new ASBrS guidelines, which differ from the American Cancer Society (ACS) and the United States Preventative Services Task Force (USPSTF) recommendations. Radiologists, she said, need to know that the new ASBrS guidelines are based on a life-years gained model and on demonstrated breast cancer survival benefits.

“Distinct from other guidelines, the ASBrS position statement includes consideration of race/ethnicity-associated variation in breast cancer burden,” said Margenthaler. “Our screening recommendations represent an opportunity to minimize breast cancer disparities through earlier detection of disease in all.”

In addition to the age specifics, the new guidelines recommended that women with a higher-than-average risk of breast cancer should undergo yearly screening and be offered risk-based age supplemental imaging. Also, the ASBrS now recommends that screening mammography should cease when a woman's life expectancy is less than ten years. Details in the new standards also offer specific guidelines related to dense breasts, heredity, and past exposure to chest wall radiation.

In a statement released by the ASBrS, ACR chair Dr. Dana Smetherman supported the new guidelines.

“Catching more cancers early by starting yearly screening at age 40 — rather than less frequent or later screening — increases the odds of successful treatment and can preserve quality of life for women,” said Smetherman. “We are pleased that ASBrS has reaffirmed their support for this most sensible approach.”

In a statement, the ASBrS asserted that new guidelines draw “on the strongest body of currently available research on the impact of breast cancer screening.” The ASBrS also acknowledged that their recommendations are different from other academic and professional guidelines. The group cited more detailed risk stratification, the specificity of actionable recommendations, and shared discussion and decision-making with patients.

The ASBrS also said that insurers would likely need to "rethink" current coverage protocols to meet some of the new recommendations.

“As a society, we felt that there was a need for a mammography screening statement that was clear, concise, and based upon the strongest evidence available regarding effectiveness in saving the most lives from breast cancer,” Margenthaler added.

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