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Brief Summary

GUIDELINE TITLE

(1) ACS guidelines for breast cancer screening: update 2003. (2) American Cancer Society Guideline for breast screening with MRI as an adjunct to mammography (2007).

BIBLIOGRAPHIC SOURCE(S)

GUIDELINE STATUS

This is the current release of the guideline.

This guideline plus addendum updates a previous version: Leitch AM, Dodd GD, Costanza M, Linver M, Pressman P, McGinnis L, Smith RA. American Cancer Society guidelines for the early detection of breast cancer: update 1997. CA Cancer J Clin 1997 May-Jun;47(3):150-3.

BRIEF SUMMARY CONTENT

 
RECOMMENDATIONS
 EVIDENCE SUPPORTING THE RECOMMENDATIONS
 IDENTIFYING INFORMATION AND AVAILABILITY
 DISCLAIMER

 Go to the Complete Summary

RECOMMENDATIONS

MAJOR RECOMMENDATIONS

Note from the National Guideline Clearinghouse (NGC) and the American Cancer Society (ACS): New evidence on breast magnetic resonance imaging (MRI) screening has become available since the ACS last issued guidelines for the early detection of breast cancer in 2003. A guideline panel has reviewed this evidence and developed new recommendations for women at different defined levels of risk, which can be found below under the heading "2007 Addendum."

2003 Guideline

Summary Recommendation

The American Cancer Society recommendations for breast cancer screening are presented below in abbreviated form. Readers should refer to the original full text guideline document to see the complete recommendations, along with the rationale and summary of the evidence.

Women at Average Risk

Begin mammography at age 40.

For women in their 20s and 30s, it is recommended that clinical breast examination (CBE) be part of a periodic health examination, preferably at least every three years. Asymptomatic women aged 40 and over should continue to receive a clinical breast examination as part of a periodic health examination, preferably annually.

Beginning in their 20s, women should be told about the benefits and limitations of breast self-examination (BSE). The importance of prompt reporting of any new breast symptoms to a health professional should be emphasized. Women who choose to do BSE should receive instruction and have their technique reviewed on the occasion of a periodic health examination. It is acceptable for women to choose not to do BSE or to do BSE irregularly.

Women should have an opportunity to become informed about the benefits, limitations, and potential harms associated with regular screening.

Older Women

Screening decisions in older women should be individualized by considering the potential benefits and risks of mammography in the context of current health status and estimated life expectancy. As long as a woman is in reasonably good health and would be a candidate for treatment, she should continue to be screened with mammography.

Women at Increased Risk

Women at increased risk of breast cancer might benefit from additional screening strategies beyond those offered to women of average risk, such as earlier initiation of screening, shorter screening intervals, or the addition of screening modalities other than mammography and physical examination, such as ultrasound or magnetic resonance imaging. However, the evidence currently available is insufficient to justify recommendations for any of these screening approaches.

2007 Addendum

Recommendations for Breast MRI Screening as an Adjunct to Mammography
Recommend Annual MRI Screening (Based on Evidence*)
  • BRCA mutation
  • First-degree relative of BRCA carrier, but untested
  • Lifetime risk ~20-25% or greater, as defined by BRCAPRO or other models that are largely dependent on family history
Recommend Annual MRI Screening (Based on Expert Consensus Opinion**)
  • Radiation to chest between age 10 and 30 years
  • Li-Fraumeni syndrome and first-degree relatives
  • Cowden and Bannayan-Riley-Ruvalcaba syndromes and first-degree relatives
Insufficient Evidence to Recommend for or Against MRI Screening***
  • Lifetime risk 15-20%, as defined by BRCAPRO or other models that are largely dependent on family history
  • Lobular carcinoma in situ (LCIS) or atypical lobular hyperplasia (ALH)
  • Atypical ductal hyperplasia (ADH)
  • Heterogeneously or extremely dense breast on mammography
  • Women with a personal history of breast cancer, including ductal carcinoma in situ (DCIS)
Recommend Against MRI Screening (Based on Expert Consensus Opinion)
  • Women at <15% lifetime risk

*Evidence from nonrandomized screening trials and observational studies

**Based on evidence of lifetime risk for breast cancer

***Payment should not be a barrier. Screening decisions should be made on a case-by-case basis, as there may be particular factors to support MRI. More data on these groups is expected to be published soon.

CLINICAL ALGORITHM(S)

None provided

EVIDENCE SUPPORTING THE RECOMMENDATIONS

TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

2003 Guideline

The primary evidence supporting the recommendation for periodic screening for breast cancer with mammography derives from seven randomized controlled trials (RCTs).

2007 Addendum

Recommendations for breast magnetic resonance imaging (MRI) screening as an adjunct to mammography are based on nonrandomized screening trials, observational studies, and expert consensus opinion based on lifetime risk for breast cancer.

IDENTIFYING INFORMATION AND AVAILABILITY

BIBLIOGRAPHIC SOURCE(S)

ADAPTATION

Not applicable: Guideline was not adapted from another source.

DATE RELEASED

1997 (revised 2003; addendum released 2007 Mar)

GUIDELINE DEVELOPER(S)

American Cancer Society - Disease Specific Society

SOURCE(S) OF FUNDING

American Cancer Society

GUIDELINE COMMITTEE

2003 Guideline

American Cancer Society Breast Cancer Screening Guideline Panel

High-Risk Work Group
Mammography Work Group
New Technologies Work Group
Physical Examination Work Group
Screening Older Women Work Group

2007 Addendum

American Cancer Society Breast Screening MRI Workgroup and American Cancer Society Breast Cancer Advisory Group

COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

2003 Guideline

Primary Authors: Robert A. Smith, PhD; Debbie Saslow, PhD; Kimberly Andrews Sawyer; Wylie Burke, MD, PhD; Mary E. Costanza, MD; W. Phil Evans III, MD; Roger S. Foster, Jr., MD; Edward Hendrick, PhD; Harmon J. Eyre, MD; Steven Sener, MD

High-Risk Work Group: Wylie Burke, MD, PhD, (Chair); Elizabeth Claus, MD, PhD; Mary Daly, MD, PhD; Paula Gordon, MD; Constance D. Lehman, MD, PhD; Olufunmilayo I. Olopade, MD; Wendy S. Rubinstein, MD, PhD; Debbie Saslow, PhD; Robert A. Smith, PhD

Mammography Work Group: W. Phil Evans III, MD, (Chair); Linda Warren Burhenne, MD; Carl J. D'Orsi, MD; Stephen A. Feig, MD; Amy S. Langer, MBA; A. Marilyn Leitch, MD; Stephen Sener, MD; Steven H. Woolf, MD, MPH; Bonnie C. Yankaskas, PhD; Debbie Saslow, PhD; Robert A. Smith, PhD

New Technologies Work Group: Edward Hendrick, PhD, (Chair); Maryellen Giger, PhD; Paula Gordon, MD; Valerie P. Jackson, MD; Constance D. Lehman, MD, PhD; Jeanne Petrek, MD; Edward Sickles, MD; Martin J. Yaffe, PhD; Debbie Saslow, PhD; Robert A. Smith, PhD

Physical Examination Work Group: Roger S. Foster Jr., MD, (Chair); Cornelia Baines, MD; Lynn Erdman, RN, MS; Margaret Rinehart-Ayres, PT, PhD; Ruby Senie, PhD; David J. Winchester, MD; William C. Wood, MD; Debbie Saslow, PhD; Robert A. Smith

Screening Older Women Work Group: Mary E. Costanza, MD, (Chair); Lodovico Balducci, MD; Cheryl Kidd, MPH; Jeanne Mandelblatt, MD, MPH; Barbara Monsees, MD; Peter Pressman, MD; William A. Satariano, PhD, MPH; Louise C. Walter, MD; Debbie Saslow, PhD; Robert A. Smith, PhD

Breast Cancer Advisory Group: Stephen Sener, MD, (Chair); Barbara Andreozzi, Chair; Lynn Erdman, RN, MS; W. Phil Evans III, MD; Herschel W. Lawson, MD; Jeanne Petrek, MD; Margaret Rinehart-Ayres, PT, PhD; Christy A. Russell, MD; Carolyn D. Runowicz, MD; William C. Wood, MD; Debbie Saslow, PhD

2007 Addendum

Authors: Debbie Saslow, PhD; Carla Boetes, MD, PhD; Wylie Burke, MD, PhD; Steven Harms, MD; Martin O. Leach, PhD; Constance D. Lehman, MD, PhD; Elizabeth Morris, MD; Etta Pisano, MD; Mitchell Schnall, MD, PhD; Stephen Sener, MD; Robert A. Smith, PhD; Ellen Warner, MD; Martin Yaffe, PhD; Kimberly S. Andrews; Christy A. Russell, MD

ACS Breast Cancer Advisory Group Members: Christy A. Russell, MD (Chair), Associate Professor of Medicine, Keck School of Medicine, University of Southern California, and Co-Director of USC/Norris Breast Center, Los Angeles, CA; Barbara Andreozzi, Prevention Chair, Montana Comprehensive Cancer Control Coalition; and Community Development Specialist, Montana State University Extension Service, Anaconda, MT; Gena R. Carter, MD, Radiologist, InMed Diagnostic Women's Center, Norwell, MA; Lynn Erdman, RN, MS, Senior Vice President, North Carolina and South Carolina, American Cancer Society, South Atlantic Division, Charlotte, NC; W. P. Evans, III, MD, Professor of Radiology; and Director of the University of Texas Southwestern Center for Breast Care, Dallas, TX; Herschel W. Lawson, MD, Senior Medical Advisor, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; Maggie Rinehart-Ayers, PhD, PT, Associate Professor and Director of Clinical Education, Thomas Jefferson University, Jefferson College of Health Professions, Philadelphia, PA; Carolyn D. Runowicz, MD, Professor of Obstetrics and Gynecology; NEU Chair in Experimental Oncology; and Director of the Neag Comprehensive Cancer Center, University of Connecticut Health Center, Farmington, CT; Debbie Saslow, PhD, Director, Breast and Gynecologic Cancer, Cancer Control Science Department, American Cancer Society, Atlanta, GA; Stephen Sener, MD, Vice Chairman, Department of Surgery, Evanston Northwestern Health Care, Evanston, IL; and Professor of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL; Robert A. Smith, PhD, Director, Cancer Screening, Cancer Control Science Department, American Cancer Society, Atlanta, GA; William C. Wood, MD, Professor; and Chairman, Department of Surgery, Emory University School of Medicine, Atlanta, GA

FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

2003 Guideline

Dr. Runowicz receives speaking fees and research support from Cytyc Corporation (First Cyte Ductal Lavage). Dr. Rubinstein is on the speaker´s bureau for Myriad Genetic Laboratories, Inc. Dr. D´Orsi is a medical consultant to GE Medical Systems and R2 Technology, Inc. Dr. Feig is on the medical advisory board of R2 Technology, Inc., a company that sells a computer-aided detection device for mammography; he does not receive any financial remuneration or grant support from the company. Dr. Giger is a shareholder in R2 Technology, Inc.; she also has received unrestricted research support from the company in the past.

2007 Addendum

Not stated

GUIDELINE STATUS

This is the current release of the guideline.

This guideline plus addendum updates a previous version: Leitch AM, Dodd GD, Costanza M, Linver M, Pressman P, McGinnis L, Smith RA. American Cancer Society guidelines for the early detection of breast cancer: update 1997. CA Cancer J Clin 1997 May-Jun;47(3):150-3.

GUIDELINE AVAILABILITY

Electronic copies of the 2003 guideline: Available from CA: A Cancer Journal for Clinicians Web site.

Electronic copies of the 2007 addendum: Available from the CA: A Cancer Journal for Clinicians Web site.

Print copies: Available from the American Cancer Society, 250 Williams St., Suite 600, Atlanta, GA 30303; Web site: www.cancer.org.

AVAILABILITY OF COMPANION DOCUMENTS

PATIENT RESOURCES

The following are available:

Also available by calling 1-800-ACS-2345.

Please note: This patient information is intended to provide health professionals with information to share with their patients to help them better understand their health and their diagnosed disorders. By providing access to this patient information, it is not the intention of NGC to provide specific medical advice for particular patients. Rather we urge patients and their representatives to review this material and then to consult with a licensed health professional for evaluation of treatment options suitable for them as well as for diagnosis and answers to their personal medical questions. This patient information has been derived and prepared from a guideline for health care professionals included on NGC by the authors or publishers of that original guideline. The patient information is not reviewed by NGC to establish whether or not it accurately reflects the original guideline's content.

NGC STATUS

This summary was completed by ECRI on March 12, 1999. The information was verified by the guideline developer as of February 28, 2000. This summary was updated by ECRI on July 21, 2003. The information was verified by the guideline developer on August 13, 2003. This NGC summary was updated by ECRI Institute on February 4, 2008. The updated information was verified by the guideline developer on February 29, 2008.

COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.

DISCLAIMER

NGC DISCLAIMER

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