The Evolving Landscape of Breast Cancer Screening

Stamatia V. Destounis, MD, FACR, FSBI, FAIUM, Chair of the American College of Radiology® (ACR®) Commission on Breast Imaging, contributed this piece.

Over the past four decades, Breast Cancer Awareness Month has helped bring breast health to the forefront, helping to save more than half a million lives according to the National Breast Cancer Foundation, Inc. Still, too many women — especially those at higher risk — are diagnosed too late. This October, we spotlight the critical role of screening and risk assessment in the fight against breast cancer. 

The incidence of breast cancer in younger women has been rising modestly over the last several years, and cancers in this age group are often more aggressive and diagnosed at later stages.  ACR recommends that women talk to their doctors by age 25 to assess their breast cancer risk and determine whether earlier or supplemental screening is necessary. Factors like family history, breast density and genetic mutations (e.g., BRCA1/2) can significantly elevate risk. Identifying these early allows for tailored screening strategies that improve outcomes.

For women at average risk, ACR recommends annual screening beginning at age 40. The US Preventive Services Task Force (USPSTF), ACR, American Cancer Society, Society of Breast Imaging, American Society of Breast Surgeons and others all agree that the most lives are saved with this annual approach. 

Even the USPSTF revised their recommendations to biennial screening starting at age 40 (down from age 50). This shift, while it does not go far enough, would appear to acknowledge that delaying screening can miss cancers in younger women, particularly those from minority backgrounds or with dense breast tissue, where the disease can be more aggressive.

While mammography remains the gold standard, newer imaging technologies are enhancing detection. The U.S. Food and Drug Administration recently approved the first tool to predict five-year breast cancer risk from routine mammograms. Contrast-enhanced mammography and abbreviated MRI are also proving effective, especially for women with dense breast tissue or other high-risk factors.  Individualized risk assessment for every patient allows healthcare providers to better tailor screening recommendations to the individual, helping to ensure early detection and improved outcomes for all women.

Breast cancer affects one in eight women in their lifetime. Let’s continue the conversation between patients, radiologists and primary care providers to ensure every woman has access to the information and tools she needs for early detection and better outcomes.