According to a draft recommendation statement, the US Preventive Services Task Force recommends that women with an average risk for breast cancer begin screening at 40 years old to reduce their chances of dying of the disease.
This is an update of the 2016 recommendation. In that report, the task force suggested that women begin screening for breast cancer at 50 years old and to start biennial mammograms (x-rays).
Some groups such as the American Cancer Society have already recommended that women begin mammograms when they reach their 40s.
"Our new taskforce recommendation is that women begin mammography screening for breast cancer by age 40, and continue to screen every two years until they reach age 74," said USPSTF vice chair Dr. Wanda Nicholson. She is senior associate dean at George Washington University Milken Institute School of Public Health and a professor.
The USPSTF is a group comprised of independent medical experts who make recommendations that influence insurance policies and help doctors to make decisions. They released a proposed update on Tuesday for its breast cancer screening guidelines. The recommendation, which is not final, will be posted on the taskforce website until June 5 for public comments. It will also include a draft of an evidence review and a draft of a modeling report.
The draft recommendation applies to all women born female, including transgender men, nonbinary individuals, and cisgender people who are at an average risk of breast cancer.
Nicholson stated that women with dense breasts or those with a history of cancer in the family generally fall under this category. However, women with a personal breast cancer history, or a history of genetic mutations such as mutations of the BRCA gene within their family, are not included, because they are at high-risk.
These updates will not affect those who are at increased risk for breast cancer and have already been encouraged to screen earlier than 40 years of age. The screening recommendations of their doctor should be followed.
Black women are most likely to die from breast cancer, which is the second-most common cancer in women.
"Screening by itself is not sufficient"
Nicholson stated that the update to the recommendation "will save more women's lives." "This is especially important for Black Women, as they are 40% more likely than other women to die of breast cancer." Nicholson said.
This draft recommendation was released a few days after a study published in JAMA Network Open revealed that Black women were more likely to die of breast cancer in their 40s than White women. The rate for Black women was also higher, at 27 deaths per 100,000 person years, as opposed to 15 deaths per 100 000 in White women. Researchers suggested that Black women begin screening earlier, at 42 years old instead of 50.
Nicholson, a USPSTF member, said that the group is calling for more research on these racial disparities in breast cancer. She also called for women with abnormal mammograms to be given an equitable follow-up, including additional testing, biopsy, and treatment if necessary.
Screening alone isn't enough. She said that if a mammogram is abnormal, then the next steps are to be taken - timely follow up, biopsies if indicated, and Black women need access to equal treatment.
She said that more research is needed to determine why inequalities occur across health systems. The draft recommendation calls for additional research on whether women with dense breasts need to be screened more often, and whether or not to screen older women.
Younger people are more susceptible to the disease
The task force members reviewed and updated breast cancer screening guidelines by analyzing data from thousands and hundreds of study abstracts on screening programs, cancer deaths and cases in the United States.
The study found that mammograms performed every two years provided moderate benefits to women aged 40-74. Benefits such as early detection of cancer outweighed potential harms such as the possibility of false positives that may lead to unnecessary testing and emotional stress.
The group concluded that the evidence was 'insufficient to determine risks and benefits' of screening women aged 75 years and older.
The task force noted that breast cancer diagnosis rates among younger women were also increasing.
Data from the population showed that breast cancer diagnosis rates have been increasing by 2% per year since 2015. Nicholson stated that more women are now being diagnosed with breast cancer in their 40s.
According to the National Cancer Institute, approximately 12.9% of all women born today in the United States will develop breast cancer during their lifetime.
She said, 'Within the recommendation we make, we call for more research in order to better understand the causes and mechanisms which may contribute to breast cancer in women of all races, but especially in Black women.' We know that Black women have more aggressive tumours.
An article published in Nature in October suggests that in many parts around the world, the incidence of cancers in adults aged 50 and under has increased since the 1990s.
Researchers wrote that the rising incidence of cancers with early onset is likely partly due to the increasing use of screenings and early detections before the age 50, in varying degrees, for certain cancer types. This includes breast, thyroid, and prostate cancers.
Researchers wrote that a growing incidence of cancers with early onset in various organs such as colorectal cancer and pancreatic carcinomas is also evident. This may not be explained fully by screening. This trend may be due to increased exposures to risk factors in childhood and/or early adulthood.
Do you screen annually or biennially?
The draft recommendation seems to be catching-up with what other organisations have been recommending since some time.
The American Cancer Society recommends that women aged 40-44 have a mammogram each year. Women 45-55 get mammograms annually. And women 55+ can opt for a schedule with mammograms once every two years.
There are similarities and differences. Now, the task force's recommendations have changed to screening women at 40 instead of 50. Our current recommendations are that women can begin an annual screening at 40 if they so choose. We recommend annual screening for women at this age while the USPSTF recommends biannual screening.
He said: 'But I think the biggest thing is that a lot women are being screened starting around their 40s. This is consistent with what most women and practitioners think about screening.
The USPSTF as well as the American Cancer Society recommend screening for women with an average risk. Dahut advised women to discuss with their doctors whether they have a greater risk for breast or ovarian cancer, and which screening practices are best for them.
In an emailed response, Dr. Laura Dominici said that the USPSTF's change to the guidelines to recommend screening mammograms in women with average risk of breast cancer over 40 is justified. It incorporates modern and'real-world' data in the science that informs the guidelines and should encourage payers to offer better coverage to women who seek breast cancer screening. She did not participate in the USPSTF's draft recommendation.
Dominici stated that this was particularly important in relation to the racial disparities of screening because Black women are more prone to developing aggressive cancers earlier, which contributes to poorer outcomes. I am pleased to see that inequities are being acknowledged in screening, but future guidelines will need to pay more attention to it.
She said that the new draft recommendation won't change the way Dr. Maxine J. Jochelson talks to her patients about breast cancer risk and the importance of screening, but it will still be the same.
Jochelson is the chief of breast imaging at Memorial Sloan Kettering in New York. She was not involved with the USPSTF's draft recommendation.
She said that if you wait longer, you will miss cancers earlier. Also, younger women and Black woman often have cancers more aggressive. I'm still going to tell them they should have a yearly screening.