On May 9, the U.S. Preventive Services Task Force (USPSTF) posted a draft recommendation statement on screening for breast cancer. The USPSTF now recommends that all women get screened for breast cancer every other year starting at age 40 years (this is a B grade recommendation, meaning the USPSTF recommends the service and that there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial). More research is needed on whether or not women with dense breasts should have additional screening with breast ultrasound or magnetic resonance imaging (MRI), and on the benefits and harms of screening in women older than 75 years (these are I statements; meaning the USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service, and that the evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined). The use of the term women in this draft recommendation includes cisgender women and other people assigned female at birth.
Breast cancer is the second most common cancer and the second most common cause of cancer death for women in the United States. While the USPSTF has consistently recognized the lifesaving value of mammography, it previously recommended that women in their 40s make an individual decision about when to start screening based on their health history and preferences. In this new recommendation, the USPSTF now recommends that all women get screened starting at age 40. This change could result in 19% more lives being saved.
This draft recommendation applies to women at an average risk of developing breast cancer. This includes people with a family history of breast cancer and people who have other risk factors, such as having dense breasts. It does not apply to people who have a personal history of breast cancer; who are at very high risk of breast cancer due to certain genetic markers or a history of high-dose radiation therapy to their chest at a young age; or who have had a high-risk lesion on previous biopsies.
The USPSTF’s draft recommendation statement, draft evidence review, and draft modeling report have been posted for public comment on the USPSTF website. Comments can be submitted from May 9 to June 5, 2023.
“New and more inclusive science about breast cancer in people younger than [age] 50 has enabled us to expand our prior recommendation and encourage all women to get screened every other year starting at age 40,” said USPSTF Immediate Past Chair Carol Mangione, MD, MSPH, Chief of the Division of General Internal Medicine and Health Services Research; the Barbara A. Levey, MD, and Gerald S. Levey, MD, Endowed Chair in Medicine; and Distinguished Professor of Medicine and Public Health at the University of California, Los Angeles (UCLA), as well as the Executive Vice Chair for Health Equity and Health Services Research in the UCLA Department of Medicine. “This new recommendation will help save lives and prevent more women from dying due to breast cancer.”
Black women are 40% more likely to die of breast cancer than White women and too often get deadly cancers at younger ages. The USPSTF recognizes this inequity and is calling for more research to understand the underlying causes and what can be done to eliminate this health disparity.
“Ensuring Black women start screening at age 40 is an important first step, yet it is not enough to improve the health inequities we face related to breast cancer,” said USPSTF Vice Chair Wanda Nicholson, MD, MPH, MBA, Senior Associate Dean for Diversity, Equity, and Inclusion and Professor of Prevention and Community Health at the Milken Institute School of Public Health at the George Washington University. “In our draft recommendation, we underscore the importance of equitable follow-up after screening and timely and effective treatment of breast cancer and are urgently calling for more research on how to improve the health of Black women.”
More Research Needed
There are many key areas where more research is essential, according to the USPSTF. In a press release, the Task Force noted the need to know how best to address the health disparities faced by Black, Hispanic, Latina, Asian, Native American, and Alaska Native women, particularly how to ensure equitable follow-up after screening. Timely and effective treatment for breast cancer has the potential to save more lives for people experiencing disparities related to racism, lack of access to care in rural communities, low income, and other factors. The USPSTF also called for more research on the benefits and harms of screening and treatment in women ages 75 and older. The balance of benefits and harms may shift as women age, but there is very limited research on the specific advantages and disadvantages of screening in this age group. Additionally, nearly half of all women have dense breasts, which increases their risk for breast cancer and means that mammograms may not work as well for them. The USPSTF noted the need for more studies that show how additional screening with breast ultrasound or MRI might help women with dense breasts.
“We know that women with dense breasts are at higher risk of breast cancer and, unfortunately, mammograms do not work as well for them,” said USPSTF member John Wong, MD, Vice Chair for Academic Affairs, Chief of the Division of Clinical Decision-Making, and a primary care physician in the Department of Medicine at Tufts Medical Center, as well as Professor of Medicine at Tufts University School of Medicine. “What we don’t know yet, and what we are urgently calling for more research on, is whether and how additional screening for women with dense breasts might be helpful, including through ultrasound, breast MRIs, or something else.”