ACR and SBI raise concerns about screening intervals, starting age, and recommendations for women with dense breasts.
The American College of Radiology (ACR) and Society of Breast Imaging (SBI) issued a statement in response to new breast cancer screening guidance from the American College of Physicians (ACP), expressing concern about recommendations related to screening age and frequency.
The new guidelines recommend biennial screening mammography for asymptomatic, average-risk women ages 50 to 74. The guidance also advises that women age 75 and older, or those with limited life expectancy, should consider stopping routine screening after discussing with their physician. Additionally, for women with dense breasts, ACP recommends considering supplemental digital breast tomosynthesis (DBT), with decisions based on potential benefits and harms, radiation exposure, availability, patient preferences, and cost. The guidance advises against the use of supplemental MRI or ultrasound for screening in average-risk patients with dense breasts.
In the statement, ACR and SBI say the new guidelines “rely on outdated and hyperbolic information, will cause continued confusion among women, and may contribute to thousands of additional breast cancer deaths each year. Thousands more women would endure extensive surgery, mastectomies, and chemotherapy for advanced cancers than if their cancers were found early by an annual mammogram.”
ACR and SBI continue to recommend annual screening mammography beginning at age 40. The organizations also advise that women undergo a breast cancer risk assessment by age 25 and that those at higher risk—including individuals with genetic mutations, strong family history, or other risk factors—discuss earlier and additional screening options with their physician.
In their statement, ACR and SBI say they do not support delaying the start of screening or extending screening intervals to every two years. They note that several organizations, including the United States Preventive Services Task Force and the American Cancer Society, recommend starting screening at age 40, although screening intervals vary across guidelines.
The groups also point to differences between ACP’s recommendations and those from other organizations with a focus on cancer care, including the National Comprehensive Cancer Network, as well as surgical and imaging specialty societies.
ACR and SBI cite modeling studies and observational data suggesting that annual screening is associated with greater reductions in breast cancer mortality compared with biennial screening. They also reference long-term data from the National Cancer Institute indicating declines in breast cancer mortality since the adoption of widespread screening.
For women with dense breasts, ACR and SBI state that additional imaging beyond DBT may be appropriate in some cases. They also note that screening decisions for women over age 74 should be individualized, as some studies suggest continued benefit in certain populations.
The organizations further state that estimates of screening-related harms—such as overdiagnosis and false-positive results—vary depending on methodology and study design, and that these factors should be considered alongside potential benefits when making screening decisions.
Overall, ACR and SBI emphasize the importance of individualized risk assessment and shared decision-making when determining breast cancer screening strategies.
ID 430560528 © Beritk | Dreamstime.com
