Ma
mmography is the reco
mmended
method for breast cancer screening of wo
men in the general population. However,
ma
mmography alone does not perfor
m as well as
ma
mmography plus supple
mental screening in high-risk wo
men. Therefore, supple
mental screening with MRI or ultrasound is reco
mmended in selected high-risk populations. Screening breast MRI is reco
mmended in wo
men at high risk for breast cancer on the basis of fa
mily history or genetic predisposition. Ultrasound is an option for those high-risk wo
men who cannot undergo MRI. Recent literature also supports the use of breast MRI in so
me wo
men of inter
mediate risk, and ultrasound
may be an option for inter
mediate-risk wo
men with dense breasts. There is insufficient evidence to support the use of other i
maging
modalities, such as ther
mography, breast-specific ga
mma i
maging, positron e
mission
ma
mmography, and optical i
maging, for breast cancer screening.
The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review includes an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.