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On May 9, 2023, The U.S. Preventive Services Task Force (USPSTF), an independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services, has issues a draft recommendation on screening for breast cancer.

The Task Force now recommends that all women get screened for breast cancer every other year starting at age 40.

According to the Task Force, more research is needed on whether or not women with dense breasts should have additional screening with breast ultrasound or MRI, and on the benefits and harms of screening in women older than 75.

Most common cancer
Breast cancer is the second most common cancer and the second most common cause of cancer death for women in the United States. While the Task Force has consistently recognized the lifesaving value of mammography, the Task Force previously recommended that women in their 40s make an individual decision about when to start screening based on their health history and preferences.

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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.

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“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,” explained Task Force immediate past chair Carol Mangione, MD, MSPH

“This new recommendation will help save lives and prevent more women from dying due to breast cancer,” Mangione added.

Mangione is the chief of the Division of General Internal Medicine and Health Services Research and a distinguished professor of medicine and public health at the University of California, Los Angeles, and the executive vice chair for Health Equity and Health Services Research in the UCLA Department of Medicine.

PopulationTask Force RecommendationGrade
Women ages 40 to 74 yearsThe USPSTF recommends biennial screening mammography for women ages 40 to 74 years.B
Women ages 40 to 74 yearsThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women age 75 years or older.I
Women with dense breastsThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of supplemental screening for breast cancer using breast ultrasonography or magnetic resonance imaging (MRI) in women identified to have dense breasts on an otherwise negative screening mammogram.I

 

Understanding inequity
Black women are 40 percent more likely to die of breast cancer than White women and too often get deadly cancers at younger ages. The Task Force recognizes this inequity and is calling for more research to understand the underlying causes and what can be done to eliminate this health 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,” noted Task Force vice chair Wanda Nicholson, MD, MPH, MBA, a senior associate dean for diversity, equity, and inclusion and professor of prevention and community health at the Milken Institute School of Public Health at the George Washington University. She is a member and vice-president-elect of the board of directors of the American Board of Obstetrics & Gynecology.

“In our draft recommendation, we underscore the importance of equitable followup 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,” Nicholson added.

Research is essential
There are many key areas where more research is essential. Additional and ongoing research is required to help address the health disparities faced by Black, Hispanic, Latina, Asian, Native American, and Alaska Native women, particularly how to ensure equitable followup after screening.

Timely and effective treatment for breast cancer has the potential to save more lives for people experiencing disparities related to racism, lack of access to care in rural communities, low income, and other factors. We also need more research on the benefits and harms of screening and treatment in women ages 75 and older. The balance of benefits and harms may shift as women age, but there is very limited research on this age population.

Additionally, nearly half of all women have dense breasts, which increases their risk for breast cancer and means that mammograms may not work as well for them. More studies are needed to show how additional screening with breast ultrasound or MRI might help women with dense breasts.

“We know that women with dense breasts are at higher risk of breast cancer and, unfortunately, mammograms do not work as well for them,” said John Wong, MD, a Task Force member, and vice chair for Academic Affairs, chief of the Division of Clinical Decision Making, and a primary care physician in the Department of Medicine at Tufts Medical Center. He is also a professor of medicine at Tufts University School of Medicine and a master of the American College of Physicians.

“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,” Wong concluded.

Average risk
This 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. The recommendations do not apply to people who have a personal history of breast cancer, who are at very high risk of breast cancer due to certain
genetic markers or 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.



 

Reference
[1] National Cancer Institute; Surveillance Epidemiology and End Results Program. Cancer Stat Facts: Female Breast Cancer. Online. Last accessed on May 9, 2023.
[2] National Cancer Institute; Surveillance Epidemiology and End Results Program. Breast: SEER 5-Year Age-Adjusted Incidence Rates, 2016-2020, by Race/Ethnicity, Female, All Ages, All Stages. Online. Last accesses on May 9, 2023.
[3] National Cancer Institute; Surveillance Epidemiology and End Results Program. SEER*Stat Database: Incidence – SEER Research Limited-Field Data with Delay-Adjustment, 22 Registries, Malignant Only, Nov 2021 Sub (2000-2019) – Linked To County Attributes – Time Dependent (1990-2019) Income/Rurality, 1969-2020 Counties. Bethesda, MD: National Cancer Institute; 2022.
[4] Henderson JT, Webber, EM, Weyrich M, Miller M, Melnikow J. Screening for Breast Cancer: A Comparative Effectiveness Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 231. Rockville, MD: Agency for Healthcare Research and Quality; 2023. AHRQ Publication No. 23-05303-EF-1.
[5] National Cancer Institute; Surveillance Epidemiology and End Results Program. Breast: SEER 5-Year Age-Adjusted Incidence Rates, 2016-2020, by Subtype, Female, All Races/Ethnicities, All Ages, All Stages. Online. Last accesses on May 9, 2023.
[6] Giaquinto AN, Sung H, Miller KD, et al. Breast cancer statistics, 2022. CA Cancer J Clin. 2022;72(6):524-541.
[7] U.S. Preventive Services Task Force. Procedure Manual. Online. Last accesses on May 9, 2023.
[8] Ciatto S, Houssami N, Bernardi D, et al. Integration of 3D digital mammography with tomosynthesis for population breast-cancer screening (STORM): a prospective comparison study. Lancet Oncol. 2013;14(7):583-589.

Featured image: A doctor examines mammogram snapshot of breast of patient on the monitors. Photo courtesy: © 2016 – 2023 Fotolia/Adobe Used with permission.

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