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NCCN Flash Updates: NCCN Guidelines^® Updated for Breast Cancer Screening and Diagnosis

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) for Breast Cancer Screening and Diagnosis. These NCCN Guidelines^® are currently available as Version 1.2020.

• Average Risk was clarified as <15% lifetime risk (BSCR-1).
• Increased Risk:
  • The recommendation to consider whole breast ultrasound or contrast-enhanced mammography for those who qualify for but cannot undergo MRI was added for those with:
    • Lifetime risk ≥20% as defined by models that are largely dependent on family history (BSCR-2)
    • Patients who receive thoracic RT between the ages of 10 and 30y
      (BSCR-2)
    • History of lobular neoplasia (LCIS/ALH) or ADH and ≥20% lifetime risk (BSCR-3)
  • Women who have a lifetime risk ≥20% as defined by models that are largely dependent on family history (BSCR-2):
    • For Annual screening mammogram: the panel clarified to begin screening 10 years prior to when the youngest family member was diagnosed with breast cancer but not prior to age 30 y or age 40 (whichever comes first).
    • For Annual breast MRI: the panel clarified to begin screening 10 years prior to when the youngest family member was diagnosed with breast cancer but not prior to age 25 y or age 40 (whichever comes first)
  • The pathway for follow-up of low clinical suspicion was defined (BSCR-6).
  • The screening interval was clarified for “Solid mass and Suspected complicated cyst”: Physical exam + imaging (ultrasound and/or diagnostic mammogram) every 6 moto Stable for 1-2 y 24 mo to assess for changes (BSCR-7).
  • The screening interval was clarified for “Follow-up Evaluation for BI-RADS category 3 “: Physical exam + imaging (ultrasound or diagnostic mammogram) for 24 mo to assess for changes (BSCR-14).
• For “Breast Screening Considerations”, the following sub-bullets are new/or modified (BSCR-A):
  • 1st bullet modified: Women should undergo breast cancer risk assessment and be counseled regarding potential benefits, risks, and limitations of breast screening in the context of their risk stratification.
  • 8th bullet modified to include: This is still within the federal guidelines for radiation dosage for mammography.
  • 9th bullet modified: Current evidence does not support the routine use of molecular imaging (eg, breast-specific gamma imaging, sestamibi scan, or positron emission mammography) as screening procedures, but there is emerging evidence that these tests. While there is emerging evidence that molecular imaging) breast-specific gamma imaging, sestamibi scan, or positron emission mammography as screening procedures may improve detection, of early breast cancers among women with mammographically dense breasts. However, whole-body effective radiation dose with these tests is substantially higher than that of mammography.
  • 12th bullet is new: For diagnostic management of pregnant patients, ultrasound and age-appropriate mammogram is recommended for palpable abnormalities. MRI with gadolinium is not recommended as the potential risk of the contrast agent to fetus is unknown.
• The following sub-bullet was modified on page BSCR-A, 2 of 2
  • Recommend Annual MRI Screening (Based on Evidence): Encourage potential role for Consider referral for genetic testing counseling for affected first-degree relatives. If testing declined or not recommended, recommend MRI.

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Drugs & Biologics Compendium (NCCN Compendium^®), the NCCN Biomarkers Compendium^®, the NCCN Chemotherapy Order Templates (NCCN Templates^®), the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), please visit NCCN.org.

To view the NCCN Guidelines for Patients^®, please visit NCCN.org/patientguidelines.

Free NCCN Guidelines apps for iPhone, iPad, and Android devices are now available! Visit NCCN.org/apps.

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