Today, the U.S. Preventive Services Task Force (USPSTF) published a final 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 and continuing through age 74 (B grade recommendation). More research is needed about whether and how additional screening might help women with dense breasts stay healthy, as well as the benefits and harms of screening in women older than 75 (I statements). The use of the term “women” in this 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 value of mammography, it had previously recommended that women in their 40s make an individual decision about when to start breast cancer screening based on their health history and preferences. In this new recommendation—published in JAMA and also available at uspstf.org—the USPSTF now recommends that all women get screened for breast cancer starting at age 40. Fundamentally, this is a shift from recommending that women start screening between the ages of 40 and 50, to recommending that all women start getting screened when they turn 40.
“More women in their 40s have been getting breast cancer, with rates increasing about 2% each year, so this recommendation will make a big difference for people across the country,” said Task Force 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. “By starting to screen all women at age 40, we can save nearly 20% more lives from breast cancer overall. This new approach has even greater potential benefit for Black women, who are much more likely to die of 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. Ensuring Black women start screening at age 40 is an important first step, yet it is not enough to improve the existing inequities.
“We need to know how best to address the health disparities related to breast cancer so all women can live longer and healthier lives,” said Task Force Vice Chair 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, and a Professor of Medicine at Tufts University School of Medicine. “Clinicians must help reduce any barriers to patients getting the recommended screening; timely, equitable, and appropriate follow-up; and effective treatment of breast cancer.”
There are many key areas where more research is essential. Some examples include improving health equity across breast cancer screening and treatment, so those experiencing disparities related to structural racism, lack of access to care in rural and other communities, low incomes, or other factors associated with risk of breast cancer death can be helped. More research on the benefits and harms of breast cancer screening and treatment in women ages 75 and older is also needed—the balance of benefits and harms may shift as women age, but there is very limited research on this 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. More studies that show how additional screening with breast ultrasound or magnetic resonance imaging might help women with dense breasts are needed.
“Women deserve to have the best science available to guide them on how to protect their health, and we’re asking the research community to prioritize studies that can show us how best to screen for breast cancer in women with dense breasts,” said Dr. Nicholson. “In the meantime, women with dense breasts should talk with their clinician about options for follow-up testing so that they can get the care that’s right for them.”
The USPSTF’s recommendation applies to women at average risk of breast cancer, as well as those with a family history of breast cancer and those with dense breasts. The recommendation 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.
