Do the New USPSTF Recommendations Go Far Enough on Mammography Screening?

In newly released draft updates for breast cancer screening recommendations, the United States Preventive Services Task Force (USPSTF) said there was sufficient evidence for recommending biennial mammography screening starting at the age of 40 for women deemed to have an average risk of breast cancer.

The USPSTF noted that lowering the age threshold for recommended breast cancer screening from 50 to 40 years of age may result in a 19 percent reduction in breast cancer-related deaths.

“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 every other year starting at age 40. This new recommendation will help save lives and prevent more women from dying due to breast cancer,” noted Carol Mangione, M.D., M.S.P.H., an immediate past chair of the USPSTF and the executive vice chair for Health Equity and Health Services Research in the Department of Medicine at the University of California, Los Angeles (UCLA).

Based on data from the Breast Cancer Surveillance Consortium (BCSC), the USPSTF maintained there was no difference between annual versus biennial screening in any age group for diagnosis of stage IIB and higher breast cancer.

In a recent tweet, Amy Patel, M.D., emphasized that annual screening mammography is an essential life-saving measure for many women.

“ … Cancers do not go away, and skipping a year can lead to a cancer progressing to be more aggressive and requiring more invasive treatment,” maintained Dr. Patel, the medical director of the Liberty Hospital Breast Care Center in Kansas City and an assistant professor at the University of Missouri-Kansas City School of Medicine. “We must continue to advocate for annual screening mammography in average risk women as well as push for risk assessment of all women by age 25 to determine if earlier and heightened imaging surveillance is warranted, particularly in high-risk patients.”

(Editor’s note: For related content, see “New ACR Guidelines Emphasize Earlier Mammography Screening for High-Risk Women,” “Study Looks at Contributing Factors to Incomplete Follow-Up for BI-RADS 3 Findings” and “Should Race and Ethnicity Factor into Starting Ages for Mammography Screening?”).

In a May 9 statement, the American College of Radiology (ACR) emphasized its agreement with the American Cancer Society and the Society of Breast Imaging (SBI) about the merits of annual breast cancer screening and urged “the USPSTF to go further to recommend annual mammography screening for average-risk women ages 40 and older.”

Noting that Black women are diagnosed with breast cancer at an earlier age on average than White women and have a reportedly 2.7-fold higher risk for triple-negative breast cancer, the Black Women’s Health Imperative (BWHI) suggested the higher likelihood of advanced breast cancer diagnoses among Black women is likely to continue with the USPSTF’s unchanged emphasis on biennial screening.¹

“BWHI has long been an advocate for beginning annual breast cancer screenings at age 40, and we are pleased to see the USPSTF’s revised guidelines align with our recommendations for starting screening. However, we are disappointed that recommendations for annual screening were not made,” noted Linda Goler Blount, M.P.H., the president and chief executive officer of BWHI.

The USPSTF also noted insufficient evidence for the use of supplemental magnetic resonance imaging (MRI) or ultrasound for women with dense breasts who have a negative screening mammogram. In contrast, recently issued breast cancer screening recommendations from the ACR include annual supplemental MRI for women with dense breasts at the age of 40 or earlier if they have additional risk factors for breast cancer. The ACR also recommends ultrasound or contrast-enhanced mammography as supplemental screening alternatives to MRI for women with dense breasts.

The updated USPSTF draft breast cancer screening recommendations can be accessed at https://www.uspreventiveservicestaskforce.org/uspstf/ . Public comments on the draft recommendation updates can be made up until June 5, 2023 at: https://www.uspreventiveservicestaskforce.org/uspstf/public-comments-and-nominations/opportunity-for-public-comment .

Reference

1. McCarthy AM, Friebel-Klingner T, Ehsan S, et al. Relationship of established risk factors with breast cancer subtypes. Cancer Med. 2021;10(18):6456-6467.