USPSTF releases new recommendations for breast cancer screenings

The United States Preventive Services Task Force (USPSTF) has announced new recommendations for breast cancer screenings, including how often women should be screened and guidance for women with dense breasts.

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In a recent interview, Carol M. Mangione, MD, chief of General Internal Medicine at UCLA Health, discussed these new recommendations for breast cancer screening.

The USPSTF currently recommends women aged 40 to 74 years receive mammography screening for breast cancer every other year. Currently, there is not enough high-quality evidence to provide recommendations for women aged over 75 years, nor about supplemental testing for women with dense breasts, according to the USPSTF.

These recommendations differ from those published in 2016, which suggested women aged 40 to 50 years speak with their doctor about whether they should pursue breast cancer screening. Since new data has indicated increased rates of breast cancer among women in their 40s, the USPSTF now recommends screening every other year.

According to Mangione, many women with dense breasts will hear that the mammogram will not be as effective for them and be unsure what other tests to receive. When the USPSTF attempted to balance the benefits and harms of other testing modalities, they were unable to obtain the evidence to make a clear recommendation for testing.

Mangione stated the main message is that screening should begin for women aged 40 years, and then occur every other year. Reducing the starting age from 50 years to 40 years can reduce breast cancer mortality by approximately 20%. Additionally, the risk of mortality is increased in Black women, providing them increased benefits from earlier screening.

The decision to recommend screening every other year instead of every year was based on multiple factors. Modeling data was used to compare benefits and harms between annual screening and biannual screening.

While annual screening led to higher rates of diagnoses, it was also associated with false positive tests leading to biopsies and overdiagnosis. Overdiagnosis may cause patients to receive unnecessary treatment, indicating a need to balance the harm of annual screening with the benefits of earlier diagnosis. This supports a biannual schedule for the best outcomes.

To wrap up, Mangione recommended bringing focus to the evidence gap among women aged over 75 years. Calling for additional research in this age group may allow an understanding of the benefits and harms of continuing to screen older patients.