AJR Am J Roentgenol. 2015 Dec;205(6):1365-71. doi: 10.2214/AJR.15.15293. Epub 2015 Sep 8.
Feig SA1.
Risk-based screening has different meanings to different people. For radiologists, risk-based screening means additional screening beyond the basic American College of Radiology (ACR), Society of Breast Imaging (SBI), and American Cancer Society (ACS) recommendations for annual mammography beginning at 40 years old and continuing as long as a woman is in generally good health and has a remaining life expectancy of at least 5–7 years and no comorbid conditions [1–3]. ACS recommends supplementary annual screening with breast MRI, in addition to mammography, for high-risk women, such as those with a lifetime risk estimate of 20–25% or greater, BRCA1 or BRCA2 mutation (or both), or a first-degree relative of a known BRCA1 or BRCA2 mutation carrier. ACS found insufficient evidence to recommend either for or against annual MRI for women having a 15–20% lifetime risk, such as those with a personal history of breast or ovarian cancer or biopsy-proven atypical ductal hyperplasia (ADH) or atypical lobular hyperplasia (ALH) [4]. Beyond guidelines for average-risk women, ACR and SBI have stipulated ages earlier than 40 years to begin annual mammography for some high-risk women, such as those with a BRCA1 or BRCA2 mutation (or both) or a first-degree relative positive for either mutation, those having a mother or sister with premenopausal breast cancer, or those with a personal history of biopsy-proven ductal carcinoma in situ (DCIS) or ADH [1].