USPSTF Lowers Age for Recommended Breast Cancer Screening to 40

Breast Cancer Image: © Giovanni Cancemi- stock.adobe.com

Women considered to be at average risk for breast cancer should undergo screening for potential breast cancer every other year starting at age 40 until 74, according to the latest recommendations from the United States Preventive Services Task Force (USPSTF) published in JAMA.¹

In the recommendation statement, the USPSTF also stated that there currently is insufficient evidence to conclusively determine the balance of the benefits and risks of screening mammography in those who are 75 years and older. Additionally, due to limited data, the potential benefits and risks of supplemental breast cancer screening with breast ultrasonography or MRI in patients with dense breasts and a negative screening mammogram remains unclear.

According to the USPSTF, both digital mammography and digital breast tomosynthesis (DBT) are effective screening modalities. To further support these recommendations, the USPSTF is calling for more research to help close this evidence gap.

Additionally, the USPSTF made an urgent call to address reasons why the mortality rate for Black women diagnosed with breast cancer is higher than White women. Despite being diagnosed with the disease less frequently than White women, Black women are 40% more likely to succumb to it.

“To achieve the benefit of screening and mitigate disparities in breast cancer mortality by race and ethnicity, it is important that all persons with abnormal screening mammography results receive equitable and appropriate follow-up evaluation and additional testing, inclusive of indicated biopsies, and that all persons diagnosed with breast cancer receive effective treatment,” study authors wrote.

In 2016, the USPSTF recommended biennial mammograms for women starting at age 50. At this time, they stressed the need for individualized screening decisions for those aged 40 to 49 and asked clinicians to weigh the risk and benefits with their patients.

Following up on the 2016 recommendation, a systematic review was conducted by the USPSTF. Here, they compared the efficacy of various mammography-based strategies by looking at a variety of factors, including the age of initiating and ending screening, screening interval, modality, use of supplemental imaging, and personalization of screening. Collaborative modeling studies from Cancer Intervention and Surveillance Modeling Network (CISNET) supported the shift to a general recommendation to start screening at age 40.

Trials began enrolling patients 30 to 40 years ago, establishing the effectiveness of screening mammography to reduce breast cancer mortality. Specifically, a meta-analysis conducted in support of the 2016 breast cancer screening recommendation found that screening mammography for those 39 to 49 years old (relative risk [RR], 0.88; 95% CI, 0.73-1.00), 50 to 59 years old (RR, 0.86; 95% CI, 0.68-0.97), and 60 to 69 years old (RR, 0.67; 95% CI, 0.54-0.83) reduced the risk of breast cancer mortality.²

Breast Cancer Cells: © LASZLO- stock.adobe.com

An updated analysis of 3 Swedish screening trials also showed there to be a relative reduction in the risk of breast cancer mortality by 15% among those who are 40 to 74 years old (RR, 0.85; 95% CI, 0.73-0.98).³

A collaborative modeling study commissioned by the USPSTF also estimated that screening every 2 years for women starting at age 40 years would avoid an additional 1.3 breast cancer deaths vs starting screening at 50 years of age. Models also estimated that screening every 2 years starting at age 40 years for Black women would prevent another 1.8 breast cancer deaths per 1000 people screened.¹

“Ensuring Black women start screening at 40 is an important first step, yet it is not enough to improve these inequities. It’s important that patients receive equitable and appropriate follow-up after screening and effective treatment of breast cancer. We are urgently calling for more evidence to better understand whether Black women could potentially be helped by different screening strategies,” wrote the study authors.

Additional Guidelines

A statement from the American College of Radiology (ACR) and the Society of Breast Imaging offered similar guidance, recommending annual screening mammography starting at age 40 for women at average risk. However, ACR also urges a more aggressive screening schedule, recommending screening continues past the age of 74. The ACR also recommends breast cancer risk assessments to start by age 25 years for all individuals.

Annual mammography screenings were also recommended by the American Cancer Society, starting at age 45 years in women at average risk. They suggest that women between the ages of 45 to 54 should be screened annually, while those 55 and older should transition to biennial screening.

Recommendations from the American College of Obstetricians and Gynecologists suggest that women at average risk of breast cancer begin screening mammography at 40 years of age. If an individual has not initiated screening in their 40s, they should begin screening mammography by no later than age 50.

They also recommend that women should be screened every 1 or 2 years. This should continue until at least 75 years of age. After 75, screening mammography may be discontinued, based on shared decision-making informed by the woman’s health status.

The American Academy of Family Physicians is in support of the 2016 USPSTF recommendation on screening for breast cancer.

REFERENCES:

1. US Preventive Services Task Force. Screening for breast cancer: US Preventive Services Task Force recommendation statement. JAMA. Published online April 30, 2024. doi:10.1001/jama.2024.5534

2. Nelson HD, Cantor A, Humphrey L, et al. Screening for breast cancer: a systematic review to update the 2009 US Preventive Services Task Force recommendation. Evidence Synthesis. No.124. Agency for Healthcare Research and Quality; 2016. AHRQ publication 14-05201-EF-1.

3. Nyström L, Bjurstam N, Jonsson H, Zackrisson S, Frisell J. Reduced breast cancer mortality after 20+ years of follow-up in the Swedish randomized controlled mammography trials in Malmö, Stockholm, and Göteborg. JMedScreen. 2017;24(1):34-42. doi:10.1177/0969141316648987