Women should be screened for breast cancer every two years starting at age 40, according to draft guidance issued Tuesday by the US Preventive Services Task Force.
That’s earlier than the independent panel of experts previously recommended: The latest guidance, from 2016, suggested biennial screenings starting at age 50, but noted that women in their 40s could talk to their doctor about getting screened screening, especially if they had a family history of breast cancer. cancer. Screening tests usually involve a mammogram, which is an X-ray image of the breast.
The change is the result of new scientific evidence, the task force said. The breast cancer rate among women ages 40 to 49 increased by 2% per year, on average, from 2015 to 2019, according to the national cancer institute.
The task force estimated that the new recommendations could prevent at least one additional breast cancer death per 1,000 women.
«Our new recommendation saves 20% more lives across the board for all women,» said Dr. Wanda Nicholson, vice chair of the task force.
She added that the recommendation does not apply to women with a personal history of breast cancer, those who have had an abnormality on a previous biopsy, women exposed to radiation to the chest at a young age, or those who have a genetic marker for cancer. breast, which may need to be checked more often.
But many radiologists think the recommendations don’t go far enough.
«They’re taking a step in the right direction, but I’m concerned about the timing of every two years,» said Dr. Melissa Durand, an associate professor in the Department of Radiology and Biomedical Imaging at Yale School of Medicine.
«Annual screening will detect the greatest number of cancers when they are at their smallest size and when treatment can be most effective,» he said. «We will lose the cancers if we test every two years.»
Many other medical groups already recommend annual screenings before age 50, including the American Cancer Society and the American College of Radiology, which recommends annual exams starting at age 40.
In 2019, about 60% of women aged 40 to 49 reported having a mammogram in the past two years, according to the Centers for Disease Control and Prevention.
“We disagree with the US task force in many different ways,” said Dr. Stamatia Destounis, chair of the American College of Radiology Commission on Breast Imaging.
The group issued guidelines last week recommend that all women have a discussion with their doctor before the age of 25 to determine if they need to be screened earlier in life. It also recommended that women with dense breasts, a breast cancer diagnosis before age 50, or a personal history of breast cancer get an MRI every year.
Durand said that most radiologists follow the recommendations of the American College of Radiology. But primary care physicians can use the task force to figure out when to refer patients for mammograms, and insurers often follow the panel’s recommendations to determine what costs to cover.
Right now, insurance companies cover annual mammograms for women who want them, but some radiologists worry that may change.
Concerns about missed cases among black women and those with dense breasts
Screening every two years won’t do much to lessen disparities in breast cancer outcomes, according to Dr. Phoebe Freer, chief of breast imaging at the Kathryn F. Kirk Center for Comprehensive Cancer Care and Cancers of the the University of Utah Women’s.
Black women are 40% more likely to die from breast cancer than white women.
Nicholson said much of that disparity is due to inequities in the health care system, such as a lack of timely follow-up after screening or unequal access to treatment. But the task force ultimately determined that the risks of annual mammograms, including false positives and unnecessary imaging or biopsies after a scan, outweighed the benefits, she said.
The radiologists also questioned why the task force did not recommend annual screening exams for women with dense breasts, which make it difficult to detect cancer.
«If you have a mammogram and it shows that you have dense breast tissue, you should have a mammogram every year and have some type of follow-up evaluation, either ultrasound or MRI,» Durand said.
Nicholson said the task force «really dug deep» for evidence that women with dense breasts required separate guidelines, but could not find any.
Radiologists say annual exams come with few risks
Although the task force’s recommendations weigh the benefits of screening for cancer against the risks of annual screenings, including radiation exposure and unnecessary biopsies, radiologists consider those risks to be relatively small.
Durand said the advanced mammography technology now widely used is unlikely to show a false positive. And only 1% to 2% of women who are tested end up needing a biopsy, Freer said.
She added that doctors are likely to detect abnormal growths that aren’t cancerous whether women have annual or biennial screenings.
Most women, Freer said, «are willing to take the risk of being called in for additional imaging and then told they’re fine.»