Women at average risk for breast cancer should begin mammogram screenings at age 40 instead of 50, according to updated recommendations in a draft statement this week from the U.S. Preventative Services Task Force (USPSTF). While the new guidance aligns with the recommendations of other cancer groups, it also sparks concerns regarding overdiagnosis and inequitable access to mammograms and treatment.
The USPSTF update builds on the 2016 recommendation that women should have their first mammogram at age 50 and have one every other year (biennially) after that until age 74, USPSTF vice chair Wanda Nicholson, MD, MPH, MBA, said in a CNN news article.
According to a USPSTF statement, this update comes as “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 in their 40s. We have long known that screening for breast cancer saves lives, and the science now supports all women getting screened, every other year, starting at age 40.”
Nicholson told CNN that the update to the recommendation “will save more lives among all women. And this is particularly important for Black women, who are 40% more likely to die from breast cancer.” She added that USPSTF members are advocating for additional research into racial inequities in breast cancer to ensure equitable access to mammograms, follow-up evaluations, additional testing, biopsies and treatment when needed.
“Screening alone is not enough,” she said. “Once someone screens with an abnormal mammogram, the subsequent steps in care must occur—timely follow-up, biopsies that are indicated—and Black women must have access to equitable treatment.”
This recommendation isn’t necessarily new. Last year, the National Comprehensive Cancer Network published Breast Cancer Screening and Diagnosis, which recommends annual mammograms for all women ages 40 and older at average risk. It also suggests that women should begin assessing their breast cancer risk as early as age 25.
The American Cancer Society (ACS) also already recommends that women ages 40 to 44 at least have the option to screen with a mammogram every year, that women 45 to 55 get mammograms every year and that women 55 and older get a mammogram every other year.
While the ACS supports the USPSTF update, its chief scientific officer William Dahut, MD, warns in an ACS news release that additional consideration may be needed to determine the frequency of screening for women under 55. “Current evidence indicates that biennial screening in this population is associated with a diagnosis of more advanced disease,” he told ACS.
“There are some similarities and some differences. So now, the new task force recommendations have changed from screening at age 50 to age 40. And our recommendations currently are that women should begin to have the opportunity to begin annual screening if they choose beginning at age 40. The big difference there is, we recommend annual screening at that age, while the task force recommends biennial screening,” Dahut told CNN.
Laura Dominici, MD, FACS, a breast cancer surgeon at Dana-Farber/Brigham and Women’s Cancer Center told CNN that the update to the guidelines is “warranted, incorporates more modern and ‘real world’ data into science informing the guidelines and will hopefully prompt payers to provide better coverage for women seeking breast cancer screening.”
She noted that this is an important update for Black women, who are more likely to develop aggressive cancers at younger ages, which can lead to later diagnosis and worse outcomes.
The USPSTF draft recommendation is intended for all people assigned female at birth, which includes cisgender women, transgender men and nonbinary people, who are at average risk for breast cancer. The updates do not apply to people at increased risk for breast cancer, who may already have been advised to begin screening at age 40 or earlier.