Women should start getting mammograms every two years once they turn 40, according to a new draft recommendation statement from the U.S. Preventive Services Task Force (USPSTF). The guidelines don’t apply to women at very high risk because of certain genetic or other factors, who may need to get screened earlier.
If approved, this update will replace the current USPSTF recommendation, released in 2016, which stated that women with average risk should begin breast cancer screening every other year from ages 50 to 74, and women in their forties should discuss screening with their doctors.
The U.S. Preventive Services Task Force defines itself as “an independent, volunteer panel of national experts in disease prevention and evidence-based medicine.” The USPSTF is funded and appointed by the U.S. Department of Health and Human Services.
New Recommendations Could Result in Nearly 20 Percent More Lives Saved
Beginning screening at age 40 rather than 50 could result in 19 percent more lives being saved, according to the USPSTF report. “New and more inclusive science about breast cancer in people younger than 50 has enabled us to expand our prior recommendation and encourage all women to get screened every other year starting at age 40,” said the Task Force’s immediate past chair, Carol Mangione, MD, in a statement. “This new recommendation will help save lives and prevent more women from dying due to breast cancer,” said Dr. Mangione.
Natasha Monga, MD, an assistant clinical professor in the department of radiology at the Ohio State University Comprehensive Cancer Center in Columbus, says the new USPSTF Breast Cancer Screening recommendations are a step in the right direction.
“However, annual screening mammography saves the most lives and is recommended by many major medical associations, including the American College of Radiology (ACR), Society of Breast Imaging (SBI), and National Comprehensive Cancer Network, among others,” says Dr. Monga.
The task force’s new draft recommendation — that average-risk women begin screening at 40 rather than 50 years of age — is what’s currently recommended by ACR, SBI, and the American Cancer Society, she adds.
“Starting annual screening at age 40 not only saves the most lives, it also allows us to detect cancers when they are smaller and more easily treatable, which may mean less aggressive intervention,” says Monga.
The new recommendation is open for public comment through June 5, after which the task force will decide whether to finalize it.
Mammograms Have Reduced Breast Cancer Mortality by 40 Percent
Breast cancer accounts for an estimated 30 percent of all new female cancers each year, second only to skin cancer, according to the American Cancer Society. There is a 1 in 8 chance that a woman will develop breast cancer in her lifetime.
Mammograms have helped reduce breast cancer mortality in the United States by close to 40 percent since 1990, according to the American College of Radiology.
New Draft Recognizes That Breast Cancer Risk Is Higher for Black Women
A big missing piece of the puzzle with breast cancer screening recommendations has been the fact that not all populations experience the same breast cancer outcomes, says Susan Brown, RN, the senior director of patient education and information at the Susan G. Komen breast cancer foundation.
According to the task force report, Black women are 40 percent more likely to die of breast cancer than white women. On top of that, Black and other minority women are more likely to be diagnosed with breast cancer before age 50, and more likely to be diagnosed with advanced-stage and more aggressive breast cancers, says Monga.
“This makes annual screening mammography starting at age 40 even more essential for these women. It is recommended that all women, particularly Black and Ashkenazi Jewish women, have breast cancer risk assessment by age 25, and discuss with their doctor whether early, more intensive screening is needed,” says Monga.
“Recent years have led to many studies detailing how other populations, particularly the Black community, could benefit from earlier breast cancer screening as a way to help achieve health equity,” says Brown.
There’s evidence that personalized, risk-based screening guidelines for Black women may improve the rate of breast cancer detection and ultimately improve outcomes, says Brown.
“Health inequities from breast cancer require more than updated screening guidelines. They require complex, multilevel structural change in our healthcare systems to ensure Black women receive the care they need at each step of the breast care continuum of care,” she says.
Younger Women Are at Higher Risk for Worse Outcomes From Breast Cancer
Young women are also specifically mentioned in the new task force report, notes Brown.
New data from recent years, including studies like the Young Women With Breast Cancer Study, are adding to what is currently known about young women who are diagnosed with breast cancer, says Brown.
“While only approximately 20 percent of breast cancers are diagnosed in women under 50 years old, these people are more likely to have worse outcomes from their breast cancer,” she says.
More Research Is Needed to Determine if Additional Testing Improves Outcomes for Women With Dense Breasts
The task force also noted that nearly half of all women have dense breasts, which means mammograms may not work as well. But more research is needed to assess “the balance of benefits and harms of supplemental screening for breast cancer,” it concluded.
A March 2023 update by the U.S. Food and Drug Administration (FDA) now requires that all women in the United States be notified about the density of their breasts. Mammogram providers will be required to implement the new standards by September 10, 2024.
PALS Act Gives Women 40 and Older Access to Annual No-Cost Breast Cancer Screenings
Under the 2015 PALS Act, annual screening mammograms from ages 40 through 49 are covered without cost-sharing, so insurance coverage has not currently changed in light of these revised draft guidelines, says Brown.
Read the full article here