The new guidelines were prompted by increasing rates of breast cancer among women in their 40s. They recommend mammograms every two years, starting at age 40.
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The new guidelines were prompted by increasing rates of breast cancer among women in their 40s. They recommend mammograms every two years, starting at age 40.
izusek/Getty Images
Breast cancer is very treatable when detected early, and mammograms, which are X-ray images of the breasts, are a reliable screening test for detecting it. Now, final guidelines released Tuesday by the U.S. Preventive Services Task Force urge all women to get screened every two years, starting at age 40.
The new recommendation applies to all people assigned female at birth and at average risk of breast cancer.
The recommendation is based on a review of new evidence by a panel of experts independent of the task force. Until now, women in their 40s were encouraged to talk with their health care provider about when to start mammograms based on their personal risks.
The task force’s previous recommendation was that women begin mammograms at age 50 and that women ages 40 to 49 consider it, based on personal risk. The American Cancer Society recommends that women ages 40 to 44 who are at “average” risk “be given the opportunity” to begin screening, but does not recommend it for all women up to age 45.
The evidence has shifted in favor of recommending mammography for all women age 40, says Dr. Carol Mangione, an internal medicine specialist at UCLA who served as chair of the U.S. Preventive and Co-Services Task Force. -author of the new recommendation.
“New, more inclusive scientific knowledge about breast cancer in women under 50 has allowed us to expand our previous recommendation,” says Mangione. Mangione highlights the increase in breast cancer among people in their forties. “There are many more women with breast cancer, and that influences our recommendations,” she says.
The task force’s recommendations are considered the gold standard because they are based on a thorough review of the evidence by a group of independent experts. Many doctors follow the task force’s guidelines. The Affordable Care Act requires most private health insurers to cover annual mammograms without cost sharing, making them free for patients.
Breast cancer is the second leading cause of cancer death among women. About 42,000 women and 500 men die from the disease each year, according to the CDC.
“If all women followed our new recommendation, we could reduce breast cancer mortality in the United States by about 20 percent,” says Mangione, saving about 8,000 lives per year. “This represents a significant reduction in breast cancer mortality,” she says.
Black women are 40% more likely to die from breast cancer. So the new recommendation is “incredibly important” in addressing this disparity, Mangione says. “It’s actually starting at age 40 that black women in our country see the most benefit,” she says.
When someone is diagnosed with breast cancer, there are many interactions with the healthcare system, from screening to biopsy to treatment. “Because of structural racism and health equity issues, there is likely a step forward at every step of this journey for Black women,” says Mangione. “The cumulative effect is that they end up with higher mortality.”
To address this health disparity, the task force “urgently calls” for more research.
Women with a family history or genetic risk factors who are at high risk for breast cancer can begin screening before age 40, and there are separate screening recommendations for women at high risk. But for women at average risk, there has already been debate about what age to start and how often.
Mangione says the task force “considered carefully” whether annual screening would save more lives than twice-yearly screening. So far, “we’ve found that every other year is the optimal strategy,” she says, although she believes more evidence is needed.
“Believe it or not, there has never been a clinical trial in the United States comparing an annual period to a semi-annual period with our current technology and treatments,” Mangione says. “There is a great lack of evidence.” The task force also calls for more research to better understand whether people with dense breasts, which can make breast cancer harder to detect, might benefit from additional screening such as breast ultrasound or MRI.
Several medical groups have recommendations for breast cancer screening. The American College of Obstetricians and Gynecologists recommends that women at average risk for breast cancer have a mammogram every 1 to 2 years, starting at age 40. Thus, the new recommendation from the US Preventive Services Task Force aligns screening recommendations.
“We’re seeing a consensus,” Mangione says, that starting at age 40 and getting a mammogram every two years can be beneficial.
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