ACR Appropriateness Criteria® Female Breast Cancer Screening: 2025 Update.

Area of Science:

• Radiology
• Oncology
• Medical Imaging

Background:

• Early breast cancer detection through routine screening significantly reduces mortality and morbidity.
• Screening guidelines are stratified based on individual breast cancer risk categories: average, intermediate, and high.
• Various imaging modalities are employed for breast cancer screening, with specific recommendations varying by risk level.

Purpose of the Study:

• To outline current evidence-based guidelines for breast cancer screening modalities.
• To detail screening recommendations across different breast cancer risk categories.
• To explain the methodology behind the American College of Radiology Appropriateness Criteria.

Main Methods:

• Systematic analysis of peer-reviewed medical literature.
• Adaptation of established methodology principles like Grading of Recommendations Assessment, Development, and Evaluation (GRADE).
• Utilization of the RAND/UCLA Appropriateness Method for determining procedure appropriateness.

Main Results:

• Mammography and digital breast tomosynthesis are recommended for all risk categories in patients with native breast tissue.
• For high-risk individuals, breast MRI screening is advised starting at ages 25-30.
• Mammography and digital breast tomosynthesis start ages for high-risk patients range from 25-40, contingent on specific risk factors.

Conclusions:

• Evidence-based guidelines, like the American College of Radiology Appropriateness Criteria, are crucial for optimizing breast cancer screening.
• Screening protocols must be individualized based on patient risk stratification.
• Expert consensus plays a vital role in guideline development when literature evidence is limited.