Regular breast cancer screening should start at age 40: USPSTF

Women who are considered to be at average risk for breast cancer should have a mammogram every other year from ages 40 to 74, according to the latest recommendations from the U.S. Preventive Services Task Force (USPSTF).

In our latest recommendations published today: Japan Automobile Manufacturers Association, the USPSTF also issued an urgent call to address why Black women are more likely to die from breast cancer than white women, and persistent questions about how to screen for cancer in nearly 40% of dense breasts. called for further research to address this. women have it. USPSTF highlighted gaps in evidence regarding the benefits and harms of continuing mammography The same applies to people aged 75 and over.

The latest USPSTF recommendations were first published last year. draft version.

In 2016, a panel recommended that women start biennial mammography 10 years later at age 50, but emphasized the need for clinicians and patients to weigh the risks and benefits of screening in their 40s. did.

The move to a general recommendation to start at age 40 is based on an extensive review of available data on mammography, including modeling from the Cancer Intervention and Surveillance Modeling Network (CISNET).

In parallel with the USPSTF report, Japan Automobile Manufacturers Association published three separate editorials.This is because these editorials Breast cancer screening Recommendations are often generated.

In an editorial, Lydia E. Pace, MD, MPH, and Nancy L. Keating, MD, MPH, argue that early screening can prevent increased breast cancer deaths, but false-positive findings He emphasized that the number of cases of overdiagnosis will also increase. .

A USPSTF-commissioned modeling study estimated that starting screening every two years starting at age 40 would avoid an additional 1.3 breast cancer deaths compared to screening at age 50, Pace and Keating said. He explained that For black women, screening every two years starting at age 40 would avoid an additional 1.8 deaths from breast cancer for every 1,000 people screened.

However, the model also found that if screening started at age 40 every two years, the rate of false-positive tests was about 8.5%, compared to 7.8% if screening started at age 50.

“Given the modest benefits of mammography screening, all women, especially those between the ages of 40 and 49, should be counseled about the benefits and harms of mammography and should be able to balance the benefits and harms for themselves. We believe we should help you decide if it fits with your priorities and values. pace and keatingboth specialize in internal medicine.

In a second editorial, Joan G. Elmore, MD, MPH, of UCLA and Christophe I. Lee, MD, MS, of the University of Washington in Seattle, wrote that the revised recommendations “highlight two major issues that call for further improvement. '', he pointed out. Focus: Addressing health inequalities associated with breast cancer outcomes and ensuring benefits for all women amid rapid advances in screening technology. ”

The UPSTSF's decision to recommend earlier starting ages for routine mammography is partly aimed at beginning to address the fact that Black women are about 40% more likely to die from breast cancer than white women. Met.

“Despite the absolute benefits of screening for Black women, modeling studies and systematic reviews highlight that the benefits of mammography (i.e., avoided breast cancer deaths) are modest for both Black women and the general population.” ” Elmore and Lee wrote.

Editors also warned against deploying artificial intelligence (AI) support tools too quickly and criticized the USPSTF for overlooking this “pressing issue.”

“Although AI algorithms have shown promise for enhancing cancer detection, their impact on patient outcomes and the balance of benefits and harms remain unclear,” Elmore and Lee wrote.

in Third Japan Automobile Manufacturers Association editorialWendy A. Berg, MD, a radiologist at the University of Pittsburgh in Pennsylvania, argued that while the latest recommendations are “an important step forward,” they are not enough.

For example, Berg said, “I was surprised to see that the USPSTF's recommendations only screen women ages 40 to 74 every other year instead of once a year.”

According to the CISNET modeling on which the USPSTF decision was based, annual screening was associated with a lower breast cancer mortality rate (35.2%) than biennial screening (28.4%) compared with no screening among women aged 40 to 74 years. %) decrease.

Berg also pointed out that regular risk assessments should begin at age 25 “to identify high-risk women who should start getting an MRI scan every year.”

of American College of Radiology (ACR) took a similar view in a statement, saying the recommendation “is not enough to save more women's lives.” The report recommends a more aggressive screening schedule starting at age 40, conducted annually rather than every other year, and continuing beyond age 74. Like Berg, ACR advocated starting breast cancer risk assessment at age 25.

of American Cancer Society It also recommends that women at average risk start getting mammograms as early as age 40 or older, and for women at high risk to get mammograms once a year. breast MRI and mammogram Every year from the age of 30.

in progress uncertainty

The USPSTF's 2024 Update highlights persistent evidence gaps in several key areas.

For example, the USPSTF has published information on the benefits and harms of using digital breast tomosynthesis versus standard mammography for primary screening, the benefits and harms of continuing to screen women over 75, and the benefits and harms of additional screening. emphasized that there was insufficient evidence.screening by breast ultrasound examinationdigital breast tomosynthesis, or MRI for women with dense breasts who had a negative screening mammogram.

In its update, the USPSTF also noted that it is still clear that a proportion of ductal carcinoma in situ, including lesions detected through screening, ultimately do not cause harm.

Regarding women with dense breasts, the USPSTF stated that “research is needed to help clinicians and patients understand the best strategy for breast cancer screening in women known to have dense breasts.” . This includes additional screening.

Women with dense breasts should still get mammograms, but there isn't enough evidence to make a comprehensive statement about how additional screening would benefit them, says former USPSTF President Carol Mangione, M.D. said. Medscape Medical News.

“We don't want to send the message that mammography has no value for that population, because it does have high value,” said Mangione, who is also director of general medicine and health services research at UCLA Health.

She said women with dense breasts should work with their primary care physician to look at their preferences and needs holistically and make informed choices about additional screening. .

“But we can't select a global population because we don't have the studies to do that,” Mangione said.

Kelly Dooley Young is a freelance journalist based in Washington, DC.