May 9, 2023 — The U.S. Preventive Services Task Force said Tuesday in a draft recommendation statement that women should begin breast cancer screening at age 40 instead of waiting until age 50.
Critical change in age for mammograms also includes recommendations for screening every two years and sets a specific age of 74.
The staff’s rating system shows strong confidence in the evidence to benefit from the changes, which means doctors should encourage their patients to get screened as appropriate.
The influential Federal Advisory Committee last updated these recommendations in 2016. At the time, the task force recommended routine mammograms starting at age 50.
In the 2016 recommendations, “We felt that women could begin screening in their 40s depending on how they feel about the harms and benefits in the individual subjective decision,” said task force member John Wong, MD, chief clinical decision maker and primary officer. A caring physician at Tufts Medical Center. “In this draft recommendation, we now recommend screening for all women starting at age 40.”
Wong said there were two main factors driving the change. One is that more women are being diagnosed with breast cancer in their 40s. The other is that of a growing body of Evidence appears Black women develop breast cancer at a younger age, are more likely to die from breast cancer, and may benefit from earlier screening.
“It is now clear that screening every two years starting at age 40 has the potential to save about 20% of lives among all women, and there is a greater potential benefit for black women, who are at a higher risk of dying from breast cancer,” said Wong.
The American Cancer Society called the draft recommendations a “significant positive change,” while noting that the task force’s recommendations only apply to women with an average risk of developing breast cancer.
American College of Radiology She already recommends yearly mammograms For women at average risk, starting at age 40 The latest guidelines for mammographypublished May 3, calls on women with a higher-than-average risk of developing breast cancer to undergo a risk assessment by age 25 to determine whether screening before age 40 is necessary.
When asked about the different perspectives, Debra Monteciolo, MD, director of breast imaging at Massachusetts General Hospital, said annual screening would save more lives than a biennial approach with staff support. Monteciolo also said that the available scientific evidence supports early evaluation as well as early screening after the age of 40 for many women, especially black women.
“These evidence-based updates should spur more informed conversations between clinician and patient and help providers save more lives,” said Monteciolo. New release.
Access to insurance
Upgrading a Staff Recommendation from a C to a B usually improves access and insurance coverage for patients. The Affordable Care Act requires insurance companies Covering the cost of services that receive A and B recommendations Without charging for contributions – a mandate intended to promote greater use of highly regarded services.
But Congress created a special solution for that It makes the mandate of the Affordable Care Act effectively apply to the 2002 task force recommendations on mammography. In those recommendations, the task force gave a grade of B for screening mammograms every year or two starting at age 40 without an age limit.
Federal lawmakers sought to provide free, shared access to mammograms to the entire population even as task force recommendations in 2009 and 2016 gave routine screening of women under 50 a C grade.
However, “it is important to note that our recommendation is based solely on the science of what works to prevent breast cancer and is not a recommendation for or against insurance coverage,” the staff acknowledged when revealing the new draft update. “Coverage decisions involve considerations that go beyond the evidence about clinical benefit, and ultimately, those decisions rest with the payers, regulators, and legislators.”
Doubts remain
The new draft recommendations also highlight persistent gaps in knowledge about the uses of mammography despite years of it. Wide use of this scanning tool.
The updated draft recommendations emphasize a lack of evidence to address key areas of concern related to screening and treatment of black women, older women, women with dense breasts, and women with ductal carcinoma in situ (DCIS), also called stage 0 breast cancer. .
The task force called for more research to address the underlying causes of higher rates of breast cancer death among Black women.
“Nearly half of all women have dense breasts, which increases their risk of breast cancer and means that mammograms may not work as well for them. We need to know more about whether additional screening might help women with dense breasts survive healthy and how is that possible,” the task force said.
The task force also called for more research on ways to reduce the risks of overdiagnosis and overtreatment of breast lesions, such as DCIS, that are identified through screening.
The staff will accept comments from the public on this draft update until June 5th.
