Panel: Begin breast cancer screening at age 40
New guidance stresses stepped-up prevention
An influential task force has recommended that women begin mammograms at age 40 and screen every other year for breast cancer until they are 74.
The U.S. Preventive Services Task Force’s updated guidance, released Tuesday, said women with an average risk for breast cancer should begin screening at 40 rather than 50. The task force said medical evidence drawn from studies suggests every-otheryear screening of breast tissue provides a “moderate net benefit” for women up to age 74.
The task force had said in its earlier guidance that women in their 40s should make an individual decision with their doctor.
The task force said there isn’t enough evidence to recommend routine screening for women 75 and older. It also did not endorse supplemental screening methods such as ultrasounds or MRIs for women with dense breast tissue. Doctors should use their judgment about ordering screening for those populations, the task force said.
Under the Affordable Care Act, insurers must cover preventive care assigned an “A” or “B” grade by the Preventive Services Task Force, an independent advisory panel that evaluates medical tests, treatments and services.
The task force assigned a “B” grade for screening mammograms for women with an average risk at ages 40 to 74. The screening recommendation does not apply to higherrisk women who have been diagnosed with breast cancer or genetic variants such as BRCA1 or BRCA2.
The task force reviewed several large medical studies to conclude the “net benefits” of such screening every two years outweighed the risks, which can include false positives that trigger anxiety, unnecessary biopsies and radiation exposure. Mammograms require Xray technology.
Disparities in care persist
Breast cancer is the secondmost common cancer among women and the second-deadliest type of cancer. In 2023, an estimated 43,170 women in the United States died of breast cancer. White women have the highest rate of breast cancer. Black women have the highest death rate from breast cancer; they are 40% more likely to die of breast cancer than white women.
A research paper detailing the task force’s recommendation in the Journal of the American Medical Association, or JAMA, noted significant disparities in access to follow-up care and treatment. The study said Black women had a rate of self-reported mammogram screening “similar to or higher than that for all women” but it noted disparities in follow-up and treatment after screening mammograms.
Black women’s rate of triple-negative cancer − a type of breast cancer that is more aggressive and diagnosed at later stages − was twice as high as white women’s, the study said.
To reduce disparities, the task force said, it’s vital that everyone diagnosed with an abnormal mammogram receive equitable follow-up evaluations and testing as well as any recommended biopsies and treatment.
‘Strong message’ for prevention
Karen Knudsen, CEO of the American Cancer Society, said the task force’s recommendation sends a “strong message to referring physicians and women that breast cancer screening should begin earlier than age 50.”
But Knudsen was disappointed the task force didn’t recommend screening for women ages 75 and older.
“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,” Knudsen said. She said the American Cancer Society “does not support stopping screening for anyone with a 10-plus year life expectancy irrespective of age.”
Agreement among experts
Douglas Marks, a medical oncologist at NYU Langone Perlmutter Cancer Center in New York City, said dropping the age to begin screening to 40 aligns with recommendations from other organizations such as the National Comprehensive Cancer Network, the American College of Obstetricians and Gynecologists and the American College of Radiology.
He also noted the task force’s draft recommendation last year signaled the move to begin screening women a decade younger after the task force’s suggestion in 2016 that routine screening begin at 50.
Effective technologies
The new guidance also says both digital mammograms and 3D mammograms are effective screening technologies. The task force said there was not enough evidence to sway it to support or oppose supplemental MRI screening. Marks noted, however, that a study found MRIs might identify breast tumors early and prevent more advanced cancer.
“We have to pay attention to these other technologies and how they may be able to at least slightly enhance our ability to screen patients,” Marks said.
Editorial says yearly screens would be better
In an accompanying editorial published with the task force’s screening recommendations in JAMA, Wendie A. Berg, a professor of radiology at the University of Pittsburgh Medical Center, said annual screenings would save more lives.
The task force’s recommendations are an “important step forward, but they stop short,” Berg wrote. “Annual mammography is as efficient as biennial mammography but with greater overall gains in years of life saved.”
Russell P. Harris, who was on the task force from 2003 to 2008, wrote in the Annals of Internal Medicine that the task force’s draft recommendations during that era would confuse the public and result in more screening “with a low probability of benefit and definite potential for harm.”