Breast cancer screenings: Task force updates guidance for women 40 and older


Women are now advised to have a mammogram every two years starting at age 40 and continuing until age 74, according to new recommendations from the U.S. Preventive Services Task Force.

The USPSTF, a voluntary group of independent medical experts whose recommendations help guide doctors’ decisions and influence insurance plans, previously recommended that biennial mammograms begin before age 50 and that the decision for women to undergo screening in their 40s “should be an individual decision”.

These New recommendations, published Tuesday in the medical journal JAMA, replace the task force’s 2016 recommendations. Some groups, such as the American Cancer Society, have already recommended that women start mammograms in their 40s.

The USPSTF’s updated recommendations apply to all people assigned female at birth, including cisgender women, transgender men, and nonbinary people at average risk for breast cancer, as well as those having a family history of breast cancer or dense breasts.

The updated recommendations do not apply to people with a personal history of breast cancer, a genetic marker or syndrome that may put them at high risk for breast cancer, such as the BRCA1 or BRCA2 genes, or to people with a history of high doses of breast cancer. radiation therapy to the chest or history of high-risk breast lesions. These patients should either follow the plan outlined by their doctor or discuss with their doctor what is best for them.

“We are making this new, updated recommendation because the latest science clearly shows that starting at age 40 and getting a mammogram every two years until age 74 can further reduce breast cancer deaths,” the president said. of the USPSTF, Dr. Wanda Nicholson, senior associate dean and professor at the Milken Institute School of Public Health at George Washington University.

The benefit of breast cancer screening is that it can help diagnose cases early, before the cancer spreads, reducing the risk of dying from the disease.

Breast cancer is the second most common cancer among women in the United States, after skin cancer, and the second leading cause of cancer death, after lung cancer.

“We can save even more lives – up to almost 20% more lives – with this updated strategy,” Nicholson said of the new recommendations.

About 1 in 8 women will develop invasive breast cancer in their lifetime, according to the American Cancer Society, and mammography (breast X-ray) remains the best tool to screen and detect the disease.

The USPSTF has received some criticism for recommending screening every two years, not every year.

“Using USPSTF terminology, annual screening is just as ‘effective’ as biennial screening, but produces greater overall reductions in advanced disease and deaths from breast cancer, and greater gains significant in years of life saved,” Dr. Wendie Berg, of the University of Pittsburgh School of Medicine, wrote in an editorial published Tuesday in the journal JAMA Oncology. She added that “it is surprising” that the USPSTF recommends biennial rather than annual screening.

“The USPSTF’s updated recommendations are an important step forward, but they stop there. Annual mammography is as effective as biennial mammography, but with greater overall gains in years of life saved,” Berg wrote. “Annual screening is particularly important for premenopausal women, especially women from racial and ethnic minority groups.

In addition to recommending biennial screening, there are other concerns regarding how the USPSTF makes general recommendations for those at average risk as well as those at average risk. those with a family history of breast cancer or dense breasts, said Molly Guthrie, vice president of policy and advocacy at the Susan G. Komen Breast Cancer Foundation.

In the United States, about half of women over 40 have dense breast tissue, according to the U.S. Food and Drug Administration, which last year updated mammography regulations to require that all U.S. screening facilities inform patients of their breast density with their mammogram results. .

“We were really surprised to see how they broke down their target audiences and it doesn’t reflect what’s standard today when it comes to identifying people at high risk for breast cancer,” Guthrie said. “I worry that this will only further muddy the waters about what people are supposed to do.”

Some experts say that people with a direct family history of breast cancer or with dense breasts should receive different screening recommendations, because both factors have been associated with an increased risk of developing breast cancer. That’s why, Guthrie said, it’s best for women to talk with their doctors about their personal medical and family history and what might be best for them individually.

“There’s been a lot of attention paid to these systems that are in place to assess people’s risk, and so, by talking with your provider, you will be able to determine your risk and the type and frequency of breast imaging that you you need. ” Guthrie said.

“The good and bad part of the task force guidelines is that they are directly tied to health plans having to cover this at no cost,” she said. And by not recommending annual screening, “we are concerned that the updated recommendation will reduce access and use of screening, which means we are likely to see the result of an increase in late-stage diagnoses , and that’s when breast cancer is more difficult.” to treat and much more costly for the health system as a whole.

In their review of published research and data, USPSTF members found no evidence supporting annual screening, Nicholson said.

“Currently, there are no randomized trials comparing annual screening to screening every two years. However, as part of our systematic review of the evidence, which is part of all of our recommendation data, we found evidence that if you compare screening every two years to every year, you don’t get increase in diagnosis of advanced breast cancer. “Nicholson said.

“When we looked at our modeling studies to assess the balance of benefits and harms, we found a much more favorable balance of benefits and harms with screening every two years than with annual screening,” said Dr. she declared. “With annual screening, you had a 50% higher false positive rate. »

False positive results for breast cancer mean that a mammogram may have been identified as abnormal when no cancer is present. This can lead to patients needing additional biopsies, repeat testing, and experiencing persistent psychological stress.

“Getting screened every two years maximizes the benefits of screening while minimizing the associated harms. These harms can include being told you might have cancer when you don’t – or being told you don’t have cancer when you do, as well as receiving a treatment that was not necessary,” according to a USPSTF patient information sheet.

The USPSTF’s passage, which says women should make individualized decisions about screening in their 40s, but that women should begin screening at age 40, appears to align more closely with what some other organizations recommend since a while.

The American Cancer Society recommends that women ages 40 to 44 should have the opportunity to have a mammogram every year, that women ages 45 to 55 should have a mammogram every year, and that women 55 and older can have to a mammogram schedule every two years.

“Today’s decision by the USPSTF represents a critical change in women’s health and the fight against breast cancer, recognizing that women in their 40s will benefit from mammography screening and sending a strong message to referring physicians and nurses. women that breast cancer screening should start earlier than age. 50,” Dr. Karen Knudsen, executive director of the American Cancer Society, said in part in a statement.

“Mammography screening is the cornerstone of our strategy to detect this life-threatening disease early, when it is easier to treat successfully,” Knudsen added. “However, we are disappointed that the USPSTF’s updated screening recommendations do not include women over 74 years of age. Millions of women over the age of 75 are in very good health and are expected to live many more years during which their risk of breast cancer remains high. .”

The American College of Obstetricians and Gynecologists recommends that women at average risk for breast cancer be screened every one to two years starting at age 40, no later than age 50. These recommendations state that screening should continue until at least age 75.

Advantages and disadvantages of screening…

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