In a significant change from previous guidance by the US Preventive Services Task Force (USPSTF) that women could begin routine mammograms at the age of 50, the new draft recommendation is shifting the age forward by a decade. Women should begin biennial mammograms at age 40 instead of waiting until 50, according to a draft recommendation from the federal Task Force. This change comes after an increase in diagnoses of breast cancer among younger patients and an especially concerning number of deaths among Black women who are already 40% more likely to die of breast cancer.
The USPSTF has long held that women can choose to begin breast cancer screening as young as 40, with a stronger recommendation that they receive the X-ray exams every 2 years from age 50 through 74.
Broader reach for more prevention power
While cancer deaths have been declining for years, breast cancer remains the second leading cancer killer of US woman, ranked only behind lung cancer. More than 43,000 women die of breast cancer in the US each year.
The new guidelines would cover more than 20 million women between 40 and 49 years old who might be at risk, but women with a family history of genetic risk of breast cancer are advised to obtain screening sooner.
“This new recommendation will help save lives and prevent more women from dying due to breast cancer,” stated Task Force chair Carol M. Mangione, MD.
The Task Force cited that Black women are 40% more likely to die of breast cancer than white women, making mammograms at 40 an especially crucial wellness step but also urged more research to better understand and combat the disparity.
“Ensuring Black women start screening at age 40 is an important first step, yet it is not enough to improve the health inequities we face related to breast cancer,” stated Task Force vice chair Wanda Nicholson, MD, MPH, MBA. “In our draft recommendation, we underscore the importance of equitable follow up after screening and timely and effective treatment of breast cancer and are urgently calling for more research on how to improve the health of Black women.”
The dense breast conundrum
In noting that nearly half of all women have dense breasts which means that diagnostic mammograms may not detect as well, the Task Force called for more research into whether additional types of testing would help.
“We know that women with dense breasts are at higher risk of breast cancer and, unfortunately, mammograms do not work as well for them,” stated Task Force member John Wong, MD. “What we don’t know yet, and what we are urgently calling for more research on, is whether and how additional screening for women with dense breasts might be helpful, including through ultrasound, breast MRIs, or something else.”
Saving 19% more
The draft recommendation applies to women at average risk of breast cancer. This includes people with a family history of breast cancer and people who have other risk factors, such as having dense breasts. It does not apply to patients who have a personal history of breast cancer, who are at very high risk of breast cancer due to certain genetic markers, those have a history of high-dose radiation therapy to their chest at a young age, or who have had a high-risk lesion on previous biopsies. The Task Force urges women concerned with their breast health to talk with their healthcare professional.
“While the Task Force has consistently recognized the lifesaving value of mammography, we previously recommended that women in their 40s make an individual decision about when to start screening based on their health history and preferences,” the group stated in a communique issued with the draft recommendation. “In this new recommendation, the Task Force now recommends that all women get screened starting at age 40. This change could result in 19 percent more lives being saved.”
Differing guidance
This most recent update—if the draft proposal is finalized—would mark a shift in the influential panel’s guidelines although it’s not likely to end some patients’ confusion as other health groups differ over when, how often, and for how long patients should undergo screening.
Health organizations have long held differing screening recommendations in efforts to strike the optimal balance between catching breast cancer early while sparing the patient stress of false positive readings.
The American Cancer Society recommends that women aged 45 to 54 should undergo mammograms every year but can choose to begin at 40 and then choose to switch to every other year at age 55.
The American College of Radiology recommends that annual mammograms begin at 40 for women at average risk of breast cancer, but urges that younger women be assessed for risk factors that may require even earlier screening.
The American College of Obstetricians and Gynecologists states that if women are at average risk of breast cancer, they should be offered mammography starting at age 40. If patients have not started screening in their 40s, they should begin having mammography no later than 50 and screening should be done every 1 to 2 years until at least age 75.
By contrast, the USPSTF states that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women 75 years and older.
The Task Force is an independent, volunteer panel of national experts in prevention and evidence-based medicine which works to improve the health of people nationwide by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications.
Its draft statement is open for public comment through June 5, after which the Task Force will decide whether to finalize it. The recommendation statement, draft evidence review, and draft modeling report are posted for review at https://www.uspreventiveservicestaskforce.org/.
The contents of this feature are not provided or reviewed by NPWH.