Breast Radiologists Say New ACP Breast Cancer Screening Guidelines are ‘Many Steps Backward’ and ‘Dangerous’
In recent interviews with Diagnostic Imaging, Wendie Berg, MD, PhD, Stamatia Destounis, MD, and Manisha Bahl, MD, shared their concerns about the recent breast cancer screening guidance from the American College of Physicians.
Breast radiologists have raised a number of concerns about the recently issued guidance from the American College of Physicians (ACP) for breast cancer screening in asymptomatic, average-risk adult women.
Key statements from the
• biennial mammography for asymptomatic, average-risk women in their 40s following “shared decision-making” with a physician about breast cancer risk, benefits and harms of screening;
• biennial mammography in asymptomatic, average-risk women 50-74 years of age;
• avoiding the use of supplemental magnetic resonance imaging (MRI) or ultrasound in women with BI-RADS category C or D breast density.1
In a recent interview with Diagnostic Imaging, Wendie Berg, MD, PhD, criticized the notion of “shared decision-making” between women in their 40s and a physician to determine if mammography screening is necessary.
“That's just not right, and it's particularly dangerous for certain groups of women who are more likely to be diagnosed at a younger age, especially Black women, Hispanic women, Asian women, and of course, women who have other risk factors. That often includes Ashkenazi Jewish women, women with dense breasts, family history, prior atypical biopsy, and, of course, personal history of breast cancer. All of those women need to be more aware to start screening or have screening at a younger age. We have this potential disparity that's created by the lack of detail, the lack of thought about the groups who are affected in these new guidelines,” emphasized Dr. Berg, a distinguished professor and Dr. Bernard F. Fisher Chair for Breast Cancer Clinical Science at the University of Pittsburgh School of Medicine, and chief scientific advisor for densebreast-info.org .
Stamatia Destounis, MD, FACR, SBI, said it was “concerning” that the ACP breast cancer screening guidance contradicted key tenets of guidelines from organizations, such as the American College of Radiology (ACR), the Society for Breast Imaging (SBI) and the National Comprehensive Cancer Network (NCCN), that recommend annual mammography exams for women of average breast cancer risk starting at 40 years of age.
“It seems like these (ACP) recommendations are so many steps backward and there is such a huge conflict with all the other guidelines from organizations that deal with breast cancer on a daily basis,” maintained Dr. Destounis, the managing partner of Elizabeth Wende Breast Care in Rochester, N.Y., and chair of the American College of Radiology’s Breast Imaging Commission.
Manisha Bahl, MD, MPH, SBI, concurred, emphasizing the importance of early detection.
“Earlier and more regular screening increases the opportunity to detect cancers at a smaller size and earlier stage when treatment is less intensive and outcomes are better,” noted Dr. Bahl, an associate professor at Harvard Medical School and breast radiologist affiliated with the Massachusetts General Hospital.
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