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lite.cnn.com - on gopher - inofficial | |
ARTICLE VIEW: | |
Task force updates guidance for breast cancer screenings for women 40 | |
and older | |
By Jacqueline Howard, CNN | |
Updated: | |
11:13 PM EDT, Wed May 1, 2024 | |
Source: CNN | |
Women are now advised to get a mammogram every other year starting at | |
age 40 and until age 74, according to new recommendations from the US | |
Preventive Services Task Force. | |
The , a volunteer panel of independent medical experts whose | |
recommendations help guide doctors’ decisions and influence insurance | |
plans, previously recommended that biennial mammograms start by age 50 | |
and the decision for women to screen in their 40s “should be an | |
individual one.” | |
These new , published Tuesday in the medical journal JAMA, replace the | |
task force’s . Some groups, such as the American Cancer Society, have | |
already recommended for women to start mammograms in their 40s. | |
The updated USPSTF recommendations apply to everyone assigned female at | |
birth, including cisgender women, transgender men and nonbinary people | |
at average risk of breast cancer, as well as those with a family | |
history of breast cancer or dense breasts. | |
The updated recommendations do not apply to people with a personal | |
history of breast cancer, a genetic marker or syndrome that may put | |
them at a high risk of breast cancer, such as the BRCA1 or BRCA2 genes, | |
or those with a history of high-dose radiation therapy to the chest or | |
a history of a high-risk breast lesions. These patients should either | |
stay on the plan outlined by their physician or talk to their doctor | |
about what’s best for them. | |
“We make this new updated recommendation because the latest science | |
clearly shows that starting at age 40 and obtaining a mammogram every | |
other year until age 74 can further reduce deaths in breast cancer,” | |
said Dr. Wanda Nicholson, a senior associate dean and professor at . | |
The benefit of screening for breast cancer is that it can help diagnose | |
cases early, before the cancer has spread, which reduces the risk of | |
dying from the disease. | |
Breast cancer is the in the United States, after skin cancer, and | |
it’s the second-leading cause of cancer death, after lung cancer. | |
“We can save even more lives — up to nearly 20% more lives — | |
with this updated strategy,” Nicholson said about the new | |
recommendations. | |
Why not screen every year? | |
About 1 in 8 women will develop invasive breast cancer in their | |
lifetime, according to the American Cancer Society, and mammography | |
— taking an X-ray of the breast — remains the best tool to screen | |
for and detect the disease. | |
The USPSTF has received some criticism for recommending to screen every | |
other year, and not annually. | |
“Using USPSTF terminology, annual screening is just as | |
‘efficient’ as biennial screening but produces greater overall | |
reductions in late-stage disease and deaths due to breast cancer, and | |
greater gains in years of life saved,” Dr. Wendie Berg, of the | |
University of Pittsburgh School of Medicine, wrote in an editorial | |
published Tuesday in the journal JAMA Oncology. She added that “it is | |
surprising” the USPSTF recommends biennial rather than annual | |
screening. | |
“The updated USPSTF recommendations are an important step forward, | |
but they stop short. Annual mammography is as efficient as biennial | |
mammography but with greater overall gains in years of life saved,” | |
Berg wrote. “Annual screening is particularly important for | |
premenopausal women, especially women in racial and ethnic minority | |
groups.” | |
Along with recommending biennial screening, there are other concerns | |
around how the USPSTF makes blanket recommendations for people at | |
average risk as well as those with a family history of breast cancer or | |
dense breasts, said Molly Guthrie, vice president of policy and | |
advocacy at the breast cancer foundation Susan G. Komen. | |
About half of women older than 40 in the United States have dense | |
breast tissue, , which last year to require that all US screening | |
facilities notify patients about the density of their breasts with | |
their mammography results. | |
“We were really surprised to see how they broke out their intended | |
audiences and it doesn’t reflect what is standard today as far as | |
identifying those people that are at high risk of breast cancer,” | |
Guthrie said. “I fear that that’s going just to further muddy the | |
water on what people are supposed to do.” | |
Some experts say that people with a direct family history of breast | |
cancer or should have different screening recommendations, as both | |
factors have been associated with an increased risk of developing | |
breast cancer. That’s why, Guthrie said, it’s best for women to | |
have conversations with their doctors about their own personal medical | |
and family history and what might be best for them individually. | |
“There’s been a lot of attention out there to these systems that | |
are in place to evaluate people’s risk, and so having that | |
conversation with your provider, you’ll be able to determine your | |
risk and the type and frequency of breast imaging you need,” Guthrie | |
said. | |
“The good and bad thing about the task force guidelines is that | |
they’re directly tied to health plans having to cover this at no | |
cost,” she said. And by not recommending annual screening, “we | |
worry that the updated recommendation will drive down access and | |
utilization of screening, meaning that we’re going to see, likely, a | |
result of increased late-stage diagnosis, and that’s when breast | |
cancer is harder to treat and much more expensive for the health care | |
system as a whole.” | |
In their review of published research and data, USPSTF members found no | |
evidence to support screening annually, Nicholson said. | |
“Currently there’s no randomized trials comparing annual screening | |
to every-other-year screening. However, as part of our systematic | |
evidence review, which is part of all of our recommendation data, we | |
did find evidence that if you compare screening every other year to | |
annually, you do not have an increase in later-stage diagnosis of | |
breast cancers,” Nicholson said. | |
“When we looked at our modeling studies to assess the balance of | |
benefits and harms, there’s a much more favorable balance of benefits | |
and harms with every-other-year screening compared to annual | |
screening,” she said. “With annual screening, you had a 50% higher | |
rate of false positive results.” | |
False positive results for breast cancer mean a mammogram may have been | |
identified as abnormal when there is no cancer present. That can lead | |
to patients needing additional biopsies, repeated tests and enduring | |
psychological stress. | |
“Getting screened every other year maximizes the benefit of screening | |
while minimizing related harms. These harms can include being told you | |
might have cancer when you don’t — or being told you don’t have | |
cancer when you do, as well as receiving treatment that was not | |
needed,” according to a . | |
The USPSTF’s shift from saying women should make individualized | |
screening decisions in their 40s to women should start screening at age | |
40 appears to align more closely with what some other organizations | |
have recommended for some time. | |
The American Cancer Society recommends that women ages 40 to 44 have | |
the option to screen with a mammogram every year, women 45 to 55 should | |
get mammograms every year, and women 55 and older can switch to a | |
schedule of mammograms every other year. | |
“The USPSTF decision today is a critical change concerning women’s | |
health and the fight against breast cancer, acknowledging that women in | |
their 40s will benefit from mammography screening, and sending a strong | |
message to referring physicians and women that breast cancer screening | |
should begin earlier than age 50,” Dr. Karen Knudsen, chief executive | |
officer at the American Cancer Society, said in part in a statement. | |
“Mammography screening is the cornerstone of our strategy to find | |
this potentially deadly disease early, when it’s easier to treat | |
successfully,” Knudsen added. “However, we are disappointed that | |
the updated USPSTF screening recommendations do not include women over | |
the age of 74. Millions of women over age 75 are in very good health | |
and are expected to live many more years during which their risk of | |
breast cancer remains high.” | |
The that women at average risk of breast cancer screen every one to two | |
years beginning at age 40, starting no later than age 50. Those | |
recommendations say screening should continue until at least age 75. | |
Benefits and harms of screening | |
To help inform the updated screening recommendations, task force | |
members analyzed data from seven randomized clinical trials and 13 | |
nonrandomized studies, as well as a new modeling study. | |
“We were able to look at the balance of benefit and harms with regard | |
to interval screening, and age to start screening,” Nicholson said. | |
The USPSTF members found that biennial breast cancer screening in women | |
ages 40 to 74 had a benefit of reducing the risk of dying from breast | |
cancer. But the evidence was insufficient to determine the balance of | |
benefits and harms for screening in women 75 or older. The task force | |
also found the evidence to be insufficient to assess the benefits and | |
harms of supplemental screening in women with dense breasts. | |
The updated recommendation includes both traditional digital | |
mammography and digital breast tomosynthesis or “3D mammography” as | |
effective screening approaches. | |
The USPSTF reviews its recommendations every five years to either | |
update or reaffirm them, Nicholson said, and the task force also | |
“consistently” looks for new evidence to inform any updates. | |
For the new recommendations, the USPSTF found “clear evidence” that | |
showed that “the incidence of invasive breast cancers in women ages | |
40 to 49 had been increasing by about 2% every year,” Nicholson | |
said. | |
“More and more women in their 40s were being diagnosed with invasive | |
breast cancers,” she said. “And for the first time we also had data | |
on Black women, and we know that Black women are nearly 40% more | |
likely to die from breast cancer compared to White women. So this was | |
important, updated observational data that we had that did provide the | |
data input for our collaborative modeling studies.” | |
The updated USPSTF recommendations note that there are “pronounced | |
inequities” in breast cancer, and Black women compared with White | |
women are more likely to be diagnosed at advanced stages and more | |
likely to die, despite being less likely to be diagnosed with the | |
disease overall. | |
The task force called for “rigorous research” to better understand | |
these inequities and identify ways to address them. | |
“We really need research to help us to better understand the | |
underlying cause of why Black women may have more aggressive cancers | |
compared to other women. It may be a combination of environmental | |
exposure and social determinants of health,” Nicholson said. | |
“Secondly, we need to know more about how to address these | |
disparities. In other words, what’s happening within our health care | |
system,” she said. “Thirdly, we need more studies on what’s the | |
best interval screening for Black women. The current science shows that | |
Black women as well should start at age 40 and continue every other | |
year to age 74. But I think we do need additional studies to look at | |
whether there are different screening strategies that would be more | |
helpful to Black women.” | |
The revised USPSTF recommendations shed light on two major issues: | |
addressing health inequities in breast cancer and ensuring all women | |
can benefit from advances made in screening technologies, Dr. Joann | |
Elmore of the David Geffen School of Medicine at the University of | |
California, Los Angeles, and Dr. Christoph Lee of the University of | |
Washington School of Medicine, wrote in a joint editorial published | |
Tuesday in the journal JAMA. | |
“Encouraging earlier screening starting at age 40 years represents | |
just one facet of the breast care continuum. These assumptions include | |
women accessing screening facilities with up-to-date technology, | |
receiving prompt diagnostic evaluations, and accessing high-quality | |
definitive treatment—a reality that does not always hold, | |
particularly for individuals belonging to groups and communities that | |
are traditionally underserved and underresourced,” Elmore and Lee | |
wrote. | |
“Overall, the updated USPSTF recommendations highlight a rapidly | |
evolving intersection of technology and equity within an already | |
complex health care ecosystem in which disparities remain a persistent | |
problem,” they wrote. “It is important that physicians continue to | |
practice the art of medicine to ensure that women make informed | |
decisions aligned with their preferences.” | |
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