The US Preventive Services Task Force is proposing that all women at average risk of breast cancer start screening at age 40 to reduce their risk of dying from the disease, according to a new draft recommendation statement.
It’s an update to the 2016 recommendation, in which the task force recommended that biennial mammograms, which are x-rays of the breasts, start at age 50 and that the decision for women to screen in their 40s “should be an individual one.”
Some groups, such as the American Cancer Society, already have been recommending for women to start mammograms in their 40s.
“Our new task force recommendation is recommending that women start screening with mammography for breast cancer at age 40 and screen every other year until age 74,” said USPSTF Vice Chair Dr. Wanda Nicholson, a senior associate dean and professor at George Washington University’s Milken Institute School of Public Health.
The USPSTF, a group of independent medical experts whose recommendations help guide doctors’ decisions and influence insurance plans, released the proposed update to its breast cancer screening guidance Tuesday. The recommendation is not final but will be available on the task force website for public comment through June 5, along with a draft evidence review and draft modeling report.
The draft recommendation is for all people assigned female at birth, including cisgender women, trans men and nonbinary people, who are at average risk for breast cancer.
Nicholson said that women with dense breasts and those with a family history of cancer generally fall into this category but not women who have a personal history of breast cancer or a family history of genetic mutations, like mutations on the BRCA gene, as they are considered to be at high risk.
The updates would not apply to those at an increased risk of breast cancer, who may already have been encouraged to screen at 40 or earlier. They should continue to follow the screening practices that their doctors have recommended.
Breast cancer is the second most common cancer among women in the United States, and rates of death are highest among Black women.
‘Screening alone is not enough’
The update to the recommendation “will save more lives among all women,” Nicholson said. “And this is particularly important for Black women, who are 40% more likely to die from breast cancer.”
The draft recommendation comes a few weeks after a study in the journal JAMA Network Open found that the rate of breast cancer deaths among women in their 40s was 27 per 100,000 person-years for Black women, compared with 15 deaths per 100,000 in White women and 11 deaths per 100,000 in American Indian, Alaska Native, Hispanic and Asian or Pacific Islander women. The researchers suggested that Black women start screening at younger ages, around 42 instead of 50.
The USPSTF members are calling for more research into these racial inequities in breast cancer, Nicholson said, and for all women who get abnormal mammogram results to receive equitable follow-up evaluations, additional testing, biopsies and treatment when needed.