May 1, 2024 – Women who’re at average risk for Breast cancer must have had Mammography every two years from age 40 to age 74, in keeping with the most recent recommendations of the U.S. Preventive Services Task Force.
In 2016, the Task Force beneficial biennial mammograms for girls starting 10 years later, at age 50. At the identical time, it stressed that doctors and patients should weigh the risks and advantages of screening for girls of their 40s. In addition to the recommendations made within the Journal of the American Medical Association wasthree separate editorials – a mirrored image of the controversy that these breast cancer screening recommendations often provoke.
Lydia E. Pace, MD, MPH, and Nancy L. Keating, MD, MPH, wrote in an editorial that while earlier screening will prevent more deaths from breast cancer, it’ll also result in more false positives and a better rate of overdiagnosis.
Pace and Keating explained that the modeling study commissioned by the USPSTF estimated that screening every two years starting at age 40 could prevent 1.3 additional breast cancer deaths in comparison with screening at age 50. For black women, screening every two years starting at age 40 could prevent 1.8 additional breast cancer deaths per 1,000 people screened.
However, the model also found that screening every two years from age 40 onwards results in more false positive tests – a rate of about 8.5% in comparison with 7.8% for those tested aged 50 and over.
The change to a general advice to start out at age 40 is predicated on a comprehensive review of accessible mammography data, including modeling from the Cancer Intervention and Surveillance Modeling Network (CISNET).
In its updated recommendations, the duty force also urged clarification of the explanation why black women die of breast cancer at higher rates than white women and urged further research to handle outstanding questions on how best to screen for cancer in dense breast tissue, which about 40% of all women have. The recommendations also highlighted gaps within the evidence regarding the advantages and harms of continued mammography after age 75.
“Given the modest benefits of mammography screening, we believe that all women – and especially those aged 40 to 49 years – should be counseled about the benefits and harms of mammography and supported in deciding whether the benefit-harm balance is consistent with their priorities and values,” wrote Pace and Keatingwho’re each specialists in internal medicine.
In a second editorial, Joann G. Elmore, MD, MPH, of UCLA, and Christoph I. Lee, MD, of the University of Washington, wrote that the revised recommendations “highlight two important issues that require greater attention: eliminating health disparities related to breast cancer outcomes and ensuring benefits for all women in the face of rapid technological advances in early detection.”
The UPSTSF's decision to recommend an earlier age for routine mammography was partly intended to reflect the undeniable fact that black women are about 40 percent more prone to die from breast cancer than white women.
“Despite the greater absolute benefit of screening for black women, the modeling study and systematic review underscore that the benefit of mammography (ie, preventing breast cancer deaths) is modest for both black women and the general population,” Elmore and Lee wrote.
The authors also warned against introducing artificial intelligence support tools too quickly and criticized the USPSTF for overlooking this “urgent problem.”
“While AI algorithms show promise for improving cancer detection, their impact on patient outcomes and the balance of benefits and harms remains uncertain,” write Elmore and Lee.
In one third JAMA editorialWendie A. Berg, MD, PhD, a radiologist on the University of Pittsburgh, argued that while the updated recommendations represented “an important step forward,” they didn’t go far enough.
Berg, for instance, expressed her surprise that “the USPSTF recommends screening for women between the ages of 40 and 74 only every two years, rather than every year.”
Compared with no screening, annual screening would scale back breast cancer mortality rates (35.2%) amongst women ages 40 to 74 greater than biennial screening (28.4%), in keeping with the modeling underlying the USPSTF decision.
In addition, Berg said, regular risk assessments must be conducted as early as age 25 “to identify women at high risk who should have annual MRI scans.”
The American College of Radiology expressed similar views in an announcement, saying the recommendations “do not go far enough to save more women's lives.” It called for a more aggressive screening schedule that begins at age 40 but occurs annually quite than every two years and continues beyond age 74. Like Berg, the group argued that breast cancer risk assessments should begin as early as age 25.
The American Cancer Society also beneficial annual mammograms, starting as early as age 40 for girls with average risk, while women with high risk MRI of the breast and a mammogram yearly from the age of 30.