Final USPSTF Recommendation Statement Advises Women Begin Receiving Mammograms at 40 Years Old

The final breast cancer screening recommendation statement has been issued by the United States Preventive Services Task Force (USPSTF) advising that women aged 40 to 74 years undergo screening every other year.^1,2 The update is a shift from the most recent guideline from 2016 which advised that women between the ages of 40 and 50 make an individual decision with their clinician on whether they should start screening based on their individual needs and preferences.³

"When we looked [at] the benefits of the slightly increased cases that you would find if you screened annually vs the potential harms associated with the much higher rate of false positives, in the balance the benefits and harms looked much better for every other year rather than every year," Carol M. Mangione, MD, said in an interview with OncLive^®. "I believe we do see a lot of false positives. [Regarding] annual screening over the course of a screening lifetime—from say age 40 to 74—[approximately] every woman screened would be predicted to have at least 2 false positives in their lifetime."

The final recommendation from the USPSTF was grade B in support of earlier screening and the authors noted that the final statement is congruent with the draft statement issued to the public in May 2023.¹ The USPSTF added that 19% more lives could be saved if all women begin breast cancer screening at the age of 40 and Black women have a 40% higher risk of dying from breast cancer than White women, leading to the change in recommendations.³

“This change was driven by two major factors. First, more women in their 40s are getting breast cancer, with rates increasing [approximately] 2% each year—which means there is more potential benefit to screening,” the USPSTF noted.² “Second, our modeling was able to use new data on screening in the United States and to look at outcomes specific to Black women for the first time. It is now clear that screening every other year starting at age 40 has the potential to save [approximately] 20% more lives from breast cancer among all women, and there is an even greater potential benefit for Black women, who are much more likely to die from breast cancer.”

Small updates were made to the final recommendations from the draft stemming from public comments to include clarification on why screening every other year is advised over annual screening, how trial data informed the guidelines, and on the lack of evidence regarding additional screening for women with dense breasts. Annual screening is not advised in the guidelines as it is unclear whether it would improve health or change the way breast cancer progresses; the USPSTF also added that annual screening may result in false breast cancer diagnoses and the receipt of unnecessary treatment.

Additionally, the USPSTF noted that the recommendations are solely applicable to women at an average risk of breast cancer, those with a family history of breast cancer, and/or those with dense breasts. Women should consult a health care professional for screening guidance if they had lesions on prior biopsies, have a personal history of breast cancer, or are at high risk for the disease due to genetic markers or receipt of prior high-radiation therapy to the chest at a young age, according to the recommendations.

“In this final recommendation statement, we are also urgently calling for more research that will allow us to build on our existing guidance and help all women live longer and healthier lives. Specifically, we need to know how best to address health disparities across screening and treatment experienced by Black, Hispanic, Latina, Asian, Pacific Islander, Native American, and Alaska Native women,” the USPSTF added in the news release. “We also need studies on what more should be done for women with dense breasts, and we need evidence on the benefits and harms of screening in older women.”

The USPSTF noted that as approximately 50% of women have dense breasts, more research in this area is critical to determine if additional screening with a breast ultrasound of MRI would provide benefit. They also issued a statement calling for additional research regarding screening women aged 75 years and older as there is not currently enough evidence for a recommendation to be formed for this population.

"In my own practice, I treat a lot of older adults as well as older women, and we have a conversation and take a holistic picture [regarding] whether to screen more [frequently] or to follow the guideline and to stop at 74 years old," Mangione said. "It depends on who the person is, what their medical conditions are, what their risk factors are, and then it’s a judgment call because we don’t know whether it’s a good idea to recommend screening in that age group."

I’m not certain about whether there are trials planned at this point [to look at testing in women 75 years of age or older], but we have made a very vigorous call for trials.

Although these new recommendations do not alter insurance coverage, the USPSTF added that most insurance companies are legally required to fully cover the cost of mammograms yearly starting at the age of 40 for women who want them.

References

1. US Preventive Services Task Force, Nicholson WK, Silverstein M, et al. Screening for breast cancer: US Preventive Services Task Force recommendation statement. JAMA. Published online April 30, 2024. doi:10.1001/jama.2024.5534
2. Breast cancer: screening. US Preventive Services Task Force. April 30, 2024. Accessed April 30, 2024. https://www.uspreventiveservicestaskforce.org/uspstf/faqs/final-faq-document/breast-cancer-screening#:~:text=Frequently%20Asked%20Questions,-Return%20to%20Recommendation&text=What%20is%20the%20Task%20Force,This%20is%20a%20B%20grade
3. Final recommendation statement breast cancer: screening. US Preventive Services Task Force. April 30, 2024. Accessed April 30, 2024.https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening#bcei-recommendation-title-area