In response to an increase in breast cancer rates among younger women, a federal task force has moved to change its guidelines for mammogram screenings for people at average risk. Here is what women need to know.
What are the new recommendations for mammograms?
The US Preventive Services Task Force Tuesday issued new draft guidance that suggests most women should start getting every-other-year mammograms at 40, not 50 as previously suggested.
The recommendation to receive biennial, instead of annual, screenings is based on modeling studies that showed that the frequency reduced potential harms associated with mammograms, including “false-positive and false-negative results, need for additional imaging and biopsy, overdiagnosis, and radiation exposure” according to Dr. John Wong, chief of the Division of Clinical Decision Making at Tufts Medical Center and a member of the task force.
But that decision is a controversial one. The American Cancer Society currently recommends women ages 40 to 44 have the option to start screening annually and women 45 to 54 screen every year. Dr. Tari King, chief of breast surgery at Brigham and Women’s Hospital, said she recommends annual mammograms from the age of 40 for average risk women and believes “the concerns about risks of false positives and anxiety are far outweighed by the benefits of screening.”
What about older women?
The task force recommends regular mammograms for women until the age of 74 and maintains that there is “insufficient evidence to assess whether regular screenings are necessary for women aged 75 years or older.” This differs from the American Cancer Society’s guidelines, which recommend screening for women ages 75 or older if they are in good health and expected to live at least 10 more years.
“Because approximately one in four breast cancer deaths each year is attributable to a diagnosis after age 75, there is no reason to believe that the benefits that are evident in older women before age 74 would not carry forward,” said Dr. William Dahut, chief scientific officer for the American Cancer Society, in a statement Tuesday.
What about women with so-called dense breast tissue?
Nearly half of all women have dense breasts, which increases their risk for breast cancer and means that mammograms do not work as well for them, according to the task force. But task force members said there is not yet enough evidence to recommend for or against additional screening with breast ultrasound or MRI. Researchers “urgently” called for more research to determine best practices for women with dense breasts, those age 75 and older, and women of color to understand how best to develop more specific guidelines for those groups.
Are the changes to the guidelines final?
No. The updated guidelines are part of a draft recommendation by the group, which is currently undergoing evidence review. Public comments will remain open until June 5.
Why did the guidelines change?
The push for earlier screening has come as breast cancer rates continue to increase among young women, especially Black women. Breast cancer diagnoses among women in their 40s increased an average of 2 percent a year between 2015 and 2019, a sharper increase than noted in previous years, according to the National Cancer Institute.
While the guidelines will likely not change how many oncologists advise their patients, the change signals a commitment to prioritize the racial inequities in breast cancer rates, said Dr. Naomi Ko, a medical oncologist at Boston Medical Center specializing in breast cancer. “The organization is saying, we care about the inequities for Black women and we’re doing what we can to move the needle on mortality equity between Black and white women,” she said.
The decision was also prompted by stark racial inequities in breast cancer deaths. Although white women have the highest rates of breast cancer, death rates are highest among Black women, who are 40 percent more likely to die from the illness than their white counterparts and almost 2.5 times more likely to die than Asian or Pacific Islander women, according to a report from the American Cancer Society.
How do the new guidelines aim to close disparities?
“Ensuring Black women start screening at 40 is an important first step, yet it is not enough to improve these inequities,” according to the task force. The new guidelines call for more research to better understand and combat the disparities. Ko said urging further research is crucial to understanding the health risks among different groups and how to better serve all patients.