From: The American Society of Breast Surgeons
Sent: Friday, May 03, 2019 1:06 PM
To: The American Society of Breast Surgeons
Subject: New ASBrS Position Statement on Screening Mammography
May 3, 2019
The American Society of Breast Surgeons (ASBrS) now recommends formal breast cancer risk assessment for all women to guide personalized screening based on calculated risk. Ideally, risk assessment should be done at age 25 or as early as reasonably possible thereafter. For average risk, the society recommends annual screening mammography starting at age 40. For a woman with higher calculated risk, the society strongly recommends access to supplemental screening methods such as MRI based on her doctor’s recommendation and her informed preference.
The leadership reflected on the rationale for adding yet another screening guideline to the existing pool of disparate recommendations that have been endorsed by various academic and professional organizations over the past ten years. Many of these groups have advocated delayed initiation of screening mammography until age 50 or prolonged intervals between imaging, citing justifications related to cost efficiency, anxiety associated with imaging or biopsy and risks of over-diagnosis. In contrast, as physicians that guide women through decisions regarding diagnosis and treatment of breast cancer every day, breast surgeons have unique perspectives regarding the value of early detection and lives saved vs cost efficiency and possible anxiety. We wanted a mammography screening statement that was clear, concise, and based upon the strongest evidence available regarding effectiveness in saving the most lives from breast cancer.
This position statement includes robust consideration of race/ethnicity-associated variation in breast cancer burden. While acknowledging the complexity of breast cancer disparities as well as the limitations of currently-available breast imaging technology, we recognize the potential value of a strong and unequivocal screening mammography recommendation in the quest to achieve health equity in the United States. The position statement concludes: “These screening recommendations for the overall diverse population of adult women represent an opportunity to minimize breast cancer disparities through earlier detection of disease in all.”
This statement was formulated by an expert panel on behalf of the board and unanimously approved by the board of directors. Please see list of panel members and their disclosures below.
Co-Chair: Shawna C. Willey, MD, FACS, Professor of Clinical Surgery, Director, MedStar Regional Breast Health Program, Chief of Surgery, MedStar Georgetown University Hospital, Washington, DC
Co-Chair: Pat Whitworth, MD, FACS, Director, Nashville Breast Center, Nashville, TN
Susan K. Boolbol, MD, Chief of Breast Surgery, Mount Sinai Beth Israel, New York, NY
Judy C. Boughey, MD, FACS, Professor of Surgery, Mayo Clinic, Rochester MN
Jill Dietz, MD, FACS, Director of Breast Center Operations, Associate Professor, Case Western Reserve University, Beechwood, OH
Alan Hollingsworth, MD, FACS, Mercy Breast Center, Mercy Hospital, Oklahoma City, OK
Kevin S. Hughes, M.D., FACS, Professor of Surgery, Harvard Medical School, Co-Director, Avon
Comprehensive Breast Evaluation Center Massachusetts General Hospital, Boston, MA
Ismail Jatoi, MD, PhD, FACS, Professor and Chief, Division of Surgical Oncology and Endocrine Surgery, University of Texas Health Center, San Antonio, TX
Julie Margenthaler, MD, FACS, Director of Breast Surgical Services of the Joanne Knight Breast Center at Siteman Cancer Center, Professor of Surgery, Washington University School of Medicine, St. Louis, MO
Lisa Newman, MD, MPH, FACS, Chief of the Section of Breast Surgery at New York-Presbyterian/Weill Cornell Medical Center and Weill Cornell Medicine, New York, NY
Walton A. Taylor, MD, FACS, Texas Health Physicians Group, Dallas, TX
Relevant Author Disclosures
Alan Hollingsworth, MD – Scientific Advisory Board, Aurora Healthcare US Corp (breast-dedicated MRI)
Kevin Hughes – Honoraria from Focal Therapeutics (Surgical implant for radiation planning with breast conservation), 23andMe, and is a founder of and has a financial interest in CRA Health (Formerly Hughes RiskApps). Dr. Hughes’s interests were reviewed and are managed by Massachusetts General Hospital and Partners Health Care in accordance with their conflict of interest policies.
Pat Whitworth MD – Principal, Targeted Medical Education; Consultant, Medtronic, Cianna Medical
The American Society of Breast Surgeons
10330 Old Columbia Road, Suite 100
Columbia, MD 21046