Breast cancer screening should begin at 40, new guidelines say

Women should be screened for breast cancer every other year starting at age 40, according to a draft guidance by the U.S. Preventive Services Task Force issued on Tuesday.

The last guidance, from 2016, suggested biennial screenings starting at age 50. It did note, however, that women in their 40s should consult their doctor about getting screened, particularly if they have a family history of breast cancer. Screening usually involves a mammogram, and an X-ray of the breast.

New scientific evidence has led to the new guidance as the rate of breast cancer among women ages 40 to 49 has increased by 2% per year, on average, from 2015 to 2019, according to the National Cancer Institute.

“Our new task force recommendation is recommending that women start screening with mammography for breast cancer at age 40 and screen every other year until age 74,” said USPSTF Vice Chair Dr. Wanda Nicholson, a senior associate dean and professor at George Washington University’s Milken Institute School of Public Health.

The USPSTF is a group of independent medical experts whose recommendations help guide doctors’ decisions and influence insurance plans. Their newest recommendation for breast cancer screening is not final but will be available on their website for public comment through June 5. 

The task force estimated that the new recommendations could prevent at least one additional breast cancer death for every 1,000 women, NBC reports

“With our new recommendation, it saves 20% more lives across the board for all women,” said Nicholson.

The recommendation does not apply to those with a personal history of breast cancer, those who have had an abnormality on a previous biopsy, women exposed to chest radiation at a younger age, or those with a genetic marker for breast cancer, who may need to be screened more frequently. 

There are some radiologists who think the recommendations don’t go far enough.

“They’re taking a step in the right direction, but I do worry about the every-other-year timing,” said Dr. Melissa Durand, an associate professor at the Yale School of Medicine Department of Radiology and Biomedical Imaging.

“Annual screening is going to catch the most amount of cancers when they’re at their smallest sizes and when treatment can be most effective,” she said. “We will miss cancers if we screen every other year.”

Radiologists also raised their concerns when the task force did not recommend annual screening for women with dense breasts, which makes it harder to detect cancer.

“If you have a mammogram and it shows that you have dense breast tissue, you should get a mammogram every year, and you should have some form of supplemental screening, whether it’s by ultrasound or MRI,” Durand said.

Although the task force’s guidelines weigh the benefits of detecting cancer against the risks of annual scans – including radiation exposure and unnecessary biopsies – radiologists consider those risks to be relatively small.

“Only 1% to 2% of women who get screened end up needing a biopsy,” according to Dr. Phoebe Freer, chief of breast imaging at the University of Utah’s Kathryn F. Kirk Center for Comprehensive Cancer Care and Women’s Cancers.

And most women, Freer said, “are willing to take the risk of being recalled for additional imaging to then be told that they’re OK.”


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