Society of Breast Imaging and American College of Radiology Recommendations for Imaging Screening for Breast Cancer A. BY IMAGING TECHNIQUE B. BY RISK FACTOR 1. Mammography 2. Ultrasound 1. Average Risk • Women at average risk for breast cancer a. Screening Mammography by Age (in Addition to Mammography) • Annual mammogram starting at age 40 – Annual screening from age 40 i. Age at Which Annual Screening • Can be considered in high-risk women Mammography Should Start for whom magnetic resonance imaging 2. High Risk (MRI) screening may be appropriate but • Women at increased risk for breast cancer Age 40 • BRCA1 or BRCA2 mutation carriers, untested who cannot have MRI for any reason – Women with certain BRCA1 or BRCA2 • Women at average risk first-degree relatives ofBRCA mutation carrier mutations or who are untested but – Annual mammogram and annual MRI have first-degree relatives (mothers, Younger Than Age 40 starting by age 30 but not before age 25 sisters, or daughters) who are proved to 3. MRI • BRCA1 or BRCA2 mutation carriers: by • Proven carriers of a deleterious BRCA mutation • Women with ≥20% lifetime risk for breast have BRCA mutations age 30, but not before age 25 • Yearly starting by age 30 (but not – Annually starting at age 30 cancer on the basis of family history before age 25) • Women with mothers or sister with • Untested first-degree relatives of proven – Annual mammography and annual MRI pre-menopausal breast cancer: by age BRCA mutation carriers starting by age 30 but not before age – Women with ≥20% lifetime risk for 30 but not before age 25, or 10 years 25, or 10 years before the age of the – Annually starting by age 30 breast cancer on the basis of family earlier than the age of diagnosis of youngest affected relative, whichever is history (both maternal and paternal) relative, whichever is later • Women with >20% lifetime risk for breast later • Yearly starting at age 30 (but not cancer on the basis of family history • Women with ≥20% lifetime risk for • History of chest irradiation received between before age 25), or 10 years earlier than – Annually starting by age 30 the age of diagnosis of the youngest breast cancer on the basis of family the ages of 10 and 30 affected relative, whichever is later history (both maternal and paternal): • Women with histories of chest irradiation – Annual mammogram and annual MRI yearly starting by age 30 but not before (usually as treatment for Hodgkin’s disease) starting 8 years after treatment; – Women with mothers or sisters with age 25, or 10 years earlier than the age – Annually starting 8 years after the mammography is not recommended pre-menopausal breast cancer of diagnosis of the youngest affected radiation therapy before age 25 • Yearly starting by age 30 (but not relative, whichever is later before age 25), or 10 years earlier than • Women with newly diagnosed breast • Personal history of breast cancer (invasive the age of diagnosis of the youngest • Women with histories of mantle radiation cancer and normal contralateral breast by carcinoma or DCIS), ovarian cancer, or affected relative, whichever is later received between the ages of 10 and 30: conventional imaging and physical biopsy diagnosis of lobular neoplasia or ADH beginning 8 years after the radiation examination – Annual mammography from time of – Women with histories of mantle therapy but not before age 25 – Single screening MRI of the contralateral diagnosis; either annual MRI or ultrasound radiation (usually for Hodgkin’s disease) breast at the time of diagnosis can also be considered; if screening MRI received between the ages of 10 and 30 • Women with biopsy-proven lobular neoplasia, ADH, DCIS, invasive breast is performed in addition to mammography, • Yearly starting 8 years after the • May be considered in women with cancer, or ovarian cancer regardless of age also performing screening ultrasound is radiation therapy, but not before age 25 between 15% and 20% lifetime risk for not necessary breast cancer on the basis of personal – Women with biopsy-proven lobular history of breast or ovarian cancer or neoplasia (lobular carcinoma in situ and ii. Age at Which Annual Screening With biopsy-proven lobular neoplasia or ADH atypical lobular hyperplasia), atypical Mammography Should Stop ductal hyperplasia (ADH), ductal • When life expectancy is <5 to 7 years on carcinoma in situ (DCIS), invasive breast the basis of age or comorbid conditions cancer or ovarian cancer • Yearly from time of diagnosis, regardless • When abnormal results of screening of age would not be acted on because of age or comorbid conditions — Excerpt from “Breast Cancer Screening with Imaging”; Lee et al; the Journal of the American College of Radiology The Breast Center of Suburban Imaging agrees with these recommendations (JACR); v7 • n1, January 2010.