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J Am Coll Radiol. 2018 Mar;15(3 Pt A):408-414. doi: 10.1016/j.jacr.2017.11.034. Epub 2018 Jan 19.

Breast Cancer Screening in Women at Higher-Than-Average Risk: Recommendations From the ACR.

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Scott & White Medical Center, Texas A&M University Health Sciences, Temple, Texas. Electronic address:
Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia.
Laura and Isaac Perlmutter Cancer Center, NYU School of Medicine, New York, New York.
H. Lee Moffitt Cancer Center, Department of Oncologic Sciences, University of South Florida, Tampa, Florida.
Division of Diagnostic Radiology, Washington University School of Medicine, St. Louis, Missouri.
University of California, San Francisco Medical Center, San Francisco, California.


Early detection decreases breast cancer mortality. The ACR recommends annual mammographic screening beginning at age 40 for women of average risk. Higher-risk women should start mammographic screening earlier and may benefit from supplemental screening modalities. For women with genetics-based increased risk (and their untested first-degree relatives), with a calculated lifetime risk of 20% or more or a history of chest or mantle radiation therapy at a young age, supplemental screening with contrast-enhanced breast MRI is recommended. Breast MRI is also recommended for women with personal histories of breast cancer and dense tissue, or those diagnosed by age 50. Others with histories of breast cancer and those with atypia at biopsy should consider additional surveillance with MRI, especially if other risk factors are present. Ultrasound can be considered for those who qualify for but cannot undergo MRI. All women, especially black women and those of Ashkenazi Jewish descent, should be evaluated for breast cancer risk no later than age 30, so that those at higher risk can be identified and can benefit from supplemental screening.


Breast cancer screening; breast MRI; breast cancer; breast cancer risk assessment; digital breast tomosynthesis; higher risk populations

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