The US Preventive Services Task Force just released new draft guidelines for breast cancer prevention, and they raise a number of questions. The panel of medical experts now recommends that women get regular mammograms by age 40 — a huge departure from previous guidelines, which said women should start having mammograms at age 50.
This is a draft recommendation — in other words, it’s not final yet — but it’s expected to become official in a few months.
Under the new draft guidelines, women should be screened for breast cancer every two years starting at age 40 to reduce their risk of dying from the disease. “While the Task Force has consistently recognized the lifesaving value of mammography, we previously recommended that women in their 40s make an individual decision about when to begin screening based on their health history and preferences,” a statement from the Task Force says. . “In this new recommendation, the Task Force now recommends that all women be screened beginning at age 40. This change could lead to 19% more lives being saved.”
But the screening recommendations differ from those of other organizations, including the American College of Obstetricians and Gynecologists and the American Cancer Society, which also differ. What’s going on here and why are breast cancer prevention guidelines so confusing? Doctors break it all down.
What led to the new mammography screening recommendations?
It’s important to point out that the screening recommendations go back to what the Task Force used to recommend around mammograms. In 2009, the organization raised the recommended age for routine mammograms from 40 to 50. At the time, the panel expressed concern that starting screening at age 40 could lead to unnecessary treatments, such as unnecessary biopsies and other therapies rather than false positives for cancer.
But since then, breast cancer diagnoses have increased — especially in women under 50 and younger black women, who die from breast cancer nearly twice as often as white women of the same age.
“New and more inclusive science about breast cancer in people under age 50 has enabled us to expand our previous recommendation and encourage all women to get screened in their 40s,” the Task Force wrote on its website. . “We’ve known for a long time that breast cancer screening saves lives, and science now supports all women who get screened every two years, starting at age 40.”
Dr. Christine Edmonds, an assistant professor of radiology at the University of Pennsylvania Hospitals, tells Yahoo Life: “There is overwhelming evidence that for women with an average lifetime risk of breast cancer, starting screening at age 40 saves the most lives. , compared to starting at age 45 or 50. In addition, most years of life are lost to breast cancer in women diagnosed in their 40s compared to women diagnosed in any other decade of their lives.
Edmonds says that if you know there’s a “minimal risk” to screening women in their 40s, “it’s with a resounding ‘yes’ that we recommend women start screening no later than age 40.”
Dr. Melissa D. Fana, director of women’s health for Suffolk County at NYU Langone’s Perlmutter Cancer Center, tells Yahoo Life that the new recommendations are a “very important step in protecting women,” adding, “We know that mammography saves lives.”
But many doctors say they’ve recommended that women be screened for breast cancer starting in their 40s, regardless of what the Task Force has said in the past. “That has been our practice, despite the previous guidance,” Dr. Parvin Peddi, a medical oncologist and director of breast medical oncology for the Margie Petersen Breast Center at Providence Saint John’s Health Center, told Yahoo Life. “There are still a lot of patients diagnosed before 50.”
Edmonds and Dr. Therese Bevers, medical director of the Cancer Prevention Center at the MD Anderson Cancer Center, also tells Yahoo Life that their medical centers recommend annual screenings for women at average risk.
How often should people who are at intermediate risk versus higher risk be screened?
The Task Force guidelines say all women should start regular mammograms by age 40, but women who are considered high risk may need to start screening even earlier.
“Women at higher risk for breast cancer should also be screened annually,” says Edmonds. “The age at which screening begins depends on their specific risk factors and risk level and should be determined by a breast cancer specialist. Those with a lifetime risk of breast cancer greater than or equal to 20% should be screened with annual breast MRI.” Factors such as your family and personal history can weigh your risk of breast cancer.)
“There are some very good risk assessments you can do online to determine your risk,” Dr. Michele Blackwood, chief of breast surgery at Rutgers Cancer Institute in New Jersey, told Yahoo Life. “If your lifetime risk is 20% or higher, you are definitely at high risk.”
Why do some organizations have different guidelines than the new recommendations from the US Preventive Services Task Force?
The American College of Obstetricians and Gynecologists recommends that women get mammograms every one to two years, starting at age 40 — and the organization has held that recommendation for years. The American Society of Breast Surgeons also recommends annual screenings at age 40, and the American Cancer Society suggests getting mammograms starting at age 45. Why is there a difference?
“We don’t know why they do what they do,” says Blackwood. “The [Task Force] recommendation to wait until 50 was confusing. Blackwood favors annual screenings, rather than the latest Task Force recommendation every two years. “Doing them annually helps you catch cancer at an earlier stage,” she says.
Many of the reasons organizations recommend annual versus bi-annual (every two years) screenings come down to risk assessment, Bevers says. “The organizations that say they have annual mammograms say: We know that fewer women will die from breast cancer this wayshe says. “The organizations that say they get screened every two years want to minimize the potential harm from false positives.”
The Task Force noted online that every year or every two years the organization analyzed models on the risks and benefits of screening and found that “when you weigh lives saved against harms such as unnecessary follow-up and treatment, women benefit more when screening every other year.”
But experts say it’s really best to have a mammogram every year. “The reasons given by the [Task Force] for biennial as opposed to annual screening — potential for callbacks, for example — are vague at best,” says Edmonds.
Why is close breast counseling not included and why is it important?
Women with dense breasts have an increased risk of developing breast cancer – something the Task Force recognizes. However, the organization also says it does not yet have specific recommendations for women with dense breasts.
“We still don’t have enough data to make clear screening recommendations in terms of who needs additional screening and how to provide this additional screening in women with dense breasts,” says Edmonds. “Much more research is needed to better understand who may need additional screening, when they warrant additional screening in their lifetime, and how they should be screened.”
What does all this mean for insurance?
The Task Force’s recommendations usually guide the insurance coverage of screening tests, Bevers says. “So a recommendation to start mammography screening at age 40 protects insurance coverage for women age 40 and older,” says Edmonds.
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