The new advice is a change from current guidelines, which officially recommend starting biannual screening by age 50, but recommend women in their 40s to discuss the benefits and risks of mammography with their doctors and make an individual decision.
Recent evidence shows that more women in their 40s are getting breast cancer, with the number of newly diagnosed women increasing by about 2 percent each year, said John Wong, an internist and professor of medicine at Tufts University School of Medicine, who is part of the working group. The panel now estimates that by starting screening earlier, doctors could find breast cancer earlier, saving more lives.
“It is now clear that screening every year, starting at age 40, has the potential to save about 20 percent more lives among all women, and has an even greater potential benefit for black women, who are much more likely to die from breast cancer,” Wong said.
Breast cancer is the most common cancer among women in the United States, other than skin cancer, and the second leading cause of cancer-related death in women. Black women are at higher risk than white women of developing breast cancer before age 40, and are more likely to develop a more aggressive form called triple-negative breast cancer, according to the American Cancer Society. cancer.
More than 43,000 women die of breast cancer each year in the United States, the data show.
A mammogram, considered the gold standard for breast cancer screening, is an X-ray of the breast that is used both to screen for signs of breast cancer and to diagnose palpable lumps found on examination.
Annual vs. biennial screening
The task force said it made its recommendations after weighing the potentially life-saving benefits of early breast cancer detection against the potential harms, including false positives that can have a psychological effect and lead to unnecessary follow-up tests and procedures, and the added – but minimal — exposure to radiation.
Many breast cancer experts applauded the task force for lowering the recommended age at which women should begin screening mammograms. Still, some professional organizations and doctors who focus on breast health say the recommendations don’t go far enough and, among other things, are calling on the task force to recommend annual mammograms for cancer screening.
Critics say the annual mammogram appointment is easier for women to remember than any other year. More importantly, they note that skipping a year between screenings will give undetected cancers more time to grow.
“A gap of two years can allow a more aggressive breast cancer to grow significantly and decrease the patient’s chance of being cured or increase the chance that she will need additional treatment,” said Maxine Yochelson, chief of the imaging service at breast at Memorial Sloan Kettering Cancer Center.
But limiting screening to every other year can also reduce the risk of false positives. About 12 percent of screening mammograms result in callbacks, where the woman is asked to return for further testing because of an abnormality on the scan. Only 4.4 percent of those calls, or 0.5 percent overall, resulted in a cancer diagnosis, according to a study of nearly 3 million screenings.
Jochelson said that while the calls are stressful for women, that shouldn’t be a reason to recommend not getting an annual screening.
“The risk of a recall is something they’ve been talking about for a long time,” she said. “Yes, women are anxious when they are called back for screening mammograms. And I certainly appreciate the concern. But then most of them have a normal exam and life goes on.”
Different screening recommendations
Most doctors and insurance companies follow the recommendations of the task force, which is an independent board of doctors and other experts appointed by the Department of Health and Human Services to evaluate care aimed at prevention or early detection.
But a number of other organizations have made different recommendations about mammography screening, and the wide variety in advice is confusing for women and their doctors.
The American Cancer Society recommends that all women begin annual screening by age 45, and some women at higher risk should begin annual screening by age 40.
The American College of Radiology and the Society for Breast Imaging say average-risk women should start annual mammograms at age 40, but by age 25, all women should talk to their doctors about individual risk factors to determine if they might earlier screening for them is needed.
The American College of Obstetricians and Gynecologists calls for mammograms every one to two years, starting at 40 for patients at average risk of breast cancer. However, when to start, there are no agreed upon guidelines for when women should stop screening.
William Dahut, chief scientific officer of the American Cancer Society, said these opposing views could be a problem.
“I think it’s hard enough for doctors to follow, much less make patients have an idea of what to do,” he said. “Simplifying the guidelines – making them so cohesive across organizations – is a goal we should all be working towards.”
Need for more research on dense breasts
The task force noted in its draft that there is insufficient evidence to assess the risks versus benefits of screening mammography in women over 74 years of age.
The recommendations apply to women with a family history of breast cancer and those who have dense breasts — a known risk factor for breast cancer that can be harder to detect with dense breast tissue.
However, they do not apply to women who have had a breast biopsy, breast cancer, or are considered high-risk, such as those with BRCA1 or BRCA2 genetic mutations. Wong said the recommendations are based on preventive medicine, and women who are at high risk should be under the care of breast cancer specialists, who will likely have more specialized guidance for them.
The new guidelines do not provide specific guidance on the use of alternative or additional forms of imaging, such as ultrasound or magnetic resonance imaging (MRI), which may be necessary when patients have dense breasts or do not have enough breast tissue for mammography.
That includes women who have had all their breast tissue removed through a mastectomy, as well as non-binary or transgender people who have had most — but not all — breast tissue removed and still need routine screening, experts said.
In March, the Food and Drug Administration updated its mammography regulations to require facilities to tell patients their breast density and suggests those with dense breasts talk to their doctor about their individual risk.
The task force states in its draft that current evidence is “insufficient to assess the balance of benefits and harms of additional breast cancer screening” in women with dense breasts.
“I’m sure it’s unsettling to be told you’re at increased risk of breast cancer, and yet we don’t have the evidence to say whether additional screening with ultrasound, MRI or anything else might be helpful or even potentially harmful.” We urgently call for more research because these women deserve to know,” Wong said.
Professional organizations, physicians and individuals can visit the task force’s website to discuss the proposed project until June 5. Once the recommendations are finalized, they will be published in JAMA, the journal of the American Medical Association.
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