The U.S. Preventive Services Task Force (USPSTF) has revised its breast cancer screening recommendations and now suggests women at average risk for breast cancer should start screening at a younger age.
The Task Force recommends mammography every other year from ages 40 to 74 years ('B' grade) -- a change from the previous guidance: biennial screening starting at age 50, with individual decision making for women in their 40s.
The USPSTF also weighed in on the question of continued screening for women ages 75 and older, and supplemental screening using breast ultrasonography or MRI in women with dense breasts on an otherwise negative screening mammogram, but concluded that current evidence is insufficient to make recommendations in either case ('I' grades).
The revised recommendation statement was published in JAMA.
Upon releasing the draft of the revised recommendation statement a year ago, the Task Force said the "new and more inclusive science about breast cancer in people younger than 50 has enabled us to expand our prior recommendation and encourage all women to get screened in their 40s. We have long known that screening for breast cancer saves lives, and the science now supports all women getting screened, every other year, starting at age 40."
Recommendations do not apply to persons who have a genetic marker or syndrome associated with a high risk of breast cancer, a history of high-dose radiation therapy to the chest at a young age, or previous breast cancer or a high-risk breast lesion on previous biopsies.
The evidence report and a modeling study supporting the new recommendations have also been published in JAMA.
The change in the recommendation brings it more in line with current clinical practice and with guidelines from other leading societies, including the American College of Radiology (ACR) and Society of Breast Imaging, both of which recommend annual screening starting at age 40. The American Cancer Society recommends all women should be given the opportunity to be screened at age 40, start annual screening at age 45, and then biennial screening at age 55, with the option to continue screening annually.
The USPSTF particularly focused on the issue of disparities in breast cancer outcomes, and the fact that Black women are 40% more likely to die of breast cancer than white women, and too often get aggressive cancers at young ages.
In an accompanying editorial in JAMA Oncology, Wendie A. Berg, MD, PhD, of the University of Pittsburgh School of Medicine, called the revised recommendation "a welcome and important change" and noted that Black and Hispanic women are more likely to be diagnosed with invasive breast cancer before the age of 50, and with more advanced stages and worse outcomes.
However, she observed, the revised recommendations "don't go far enough."
She said annual mammography is as efficient as biennial mammography, provides greater overall gains in years of life saved, and is "particularly important for premenopausal women, especially women in racial and ethnic minority groups."
Berg also pointed out that USPSTF guidelines do not apply to women at high risk for breast cancer, and suggested regular risk assessment should commence at age 25 years to identify women at high risk who should start annual MRI screening. Furthermore, she said many women with dense breasts or family history of breast cancer, or both, meet high-risk criteria for supplemental screening.
In another editorial published in JAMA, Joann G. Elmore, MD, MPH, of the University of California Los Angeles, and Christoph I. Lee, MD, MS, of the University of Washington School of Medicine in Seattle, pointed out there is an urgent need for better evidence on the topic of supplemental screening with ultrasound or magnetic resonance imaging (MRI) for women with dense breasts.
"The topic is of critical concern since starting September 2024, the [FDA] will mandate that all U.S. screening facilities inform women about their breast density with their mammography results," they wrote "It is important to recognize that nearly half of all women in the U.S. have dense breasts, a normal variation associated with a small increase in breast cancer risk similar to having an aunt with breast cancer."
Elmore and Lee also noted that while the USPSTF emphasized the need for more research in many areas, it overlooked the "pressing issue" of the use of artificial intelligence as a support tool for image interpretation.
"Historically, millions of U.S. women underwent screening mammograms with older, pre-AI computer-aided detection tools for nearly 2 decades before population-level studies revealed decreased accuracy when these tools were used," they wrote. "This historical error provides a clear warning that larger studies are required before wide adoption of newer AI tools for mammography."
Disclosures
Members of the USPSTF and authors of the evidence report had no ties to industry.
Berg reported an institutional grant from Koios Medical, grants from the Breast Cancer Research Foundation and the Pennsylvania Breast Cancer Coalition, consulting for Exai Bio, and serving as voluntary chief scientific advisor for DenseBreast-info.org and voluntary associate editor for the Journal of Breast Imaging.
Elmore reported serving as editor in chief for adult primary care topics and author of some breast cancer topics for UpToDate, serving on the editorial board of the National Institutes of Health Physician Data Query on cancer screening and prevention topics, and receiving funding from the National Cancer Institute for breast cancer-related research.
Lee reported receiving textbook royalties from McGraw Hill, Oxford University Press, and UpToDate, including for some breast cancer topics; receiving personal fees for editorial board work from the American College of Radiology; and receiving funding from the National Cancer Institute for breast cancer-related research.
Primary Source
JAMA
Source Reference: US Preventive Services Task Force "Screening for breast cancer: US Preventive Services Task Force recommendation statement" JAMA 2024; DOI: 10.1001/jama.2024.5534.
Secondary Source
JAMA
Source Reference: Henderson JT, et al "Screening for breast cancer: evidence report and systematic review for the US Preventive Services Task Force" JAMA 2024; DOI: 10.1001/jama.2023.25844.
Additional Source
JAMA Oncology
Source Reference: Berg WA "USPSTF breast cancer screening guidelines do not go far enough" JAMA Oncol 2024; DOI: 10.1001/jamaoncol.2024.0905.
Additional Source
JAMA
Source Reference: Elmore JG, Lee CI “Toward more equitable breast cancer outcomes” JAMA 2024; DOI: 10.1001/jama.2024.6052.
https://www.medpagetoday.com/hematologyoncology/breastcancer/109887
