In Significant Change, Task Force Recommends All Women Get Screened for Breast Cancer Starting at Age 40

Citing new research and rising rates of breast cancer, a new draft recommendation from the US Preventive Services Task Force (USPSTF) recommends breast cancer screenings for all cisgender women and other people assigned female at birth starting at age 40. The change could result in 19% more lives being saved, according to the USPSTF.

Image Credit: Adobe Stock - peterschreiber.media

The draft recommendation applies to women with an average risk of breast cancer, including those with a family history of breast cancer and those who have other risk factors, such as having dense breasts. It does not apply to those who have a personal history of breast cancer, who are at a very high risk of breast cancer due to 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.

Breast cancer is the second most common cancer and the second most common cause of cancer-related death for women in the United States. Previously, the USPSTF had recommended that women in their 40s make an individual decision about when to start screening based on their health history and preferences. In the new recommendation, the USPSTF now recommends that all women start receiving screening at age 40.

“New and more inclusive science about breast cancer in people younger than 50 has enabled us to expand how 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, in a press release. “This new recommendation will help save lives and prevent more women from dying due to breast cancer.”

Notably, Black women are 40% more likely to die of breast cancer than White women and are too often diagnosed with deadly cancers at younger ages. The USPSTF noted this inequity and called for more research to understand the underlying causes and steps that can be taken 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, in the press release. “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 is urgently needed in many areas, including how best to address health disparities faced by Black, Hispanic, Latina, Asian, Native American, and Alaska Native women and how to ensure equitable follow-up after screening. Timely and effective treatment can save significantly more lives for patients experiencing disparities related to racism, lack of access to care, low income, and other factors.

Research should also focus 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 data on this issue in older women.

Additionally, nearly half of all women have dense breasts, which increases the risk of breast cancer and means that mammograms may not be as effective. Future research should focus on 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, in the press release. “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.”

REFERENCE

Task Force Issues Draft Recommendation Statement on Screening for Breast Cancer. News release. US Preventive Services Task Force. May 9, 2023. Accessed May 9, 2023. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/breast-cancer-screening-draft-rec-bulletin.pdf