Breast cancer screening saves lives. Screening can result in early diagnosis and treatment, increasing the odds that those who get a breast cancer diagnosis can beat the disease. We know screening is important, but what is the right way to go about screening for breast cancer? While some medical groups, such as the American College of Radiology and the American Cancer Society, have recommended annual mammograms for women in their 40’s, others such as the United States Preventive Services Task Force (USPSTF) did not recommend screening to start until the age of fifty and then only every 2 years. This may soon change.
The USPSTF recently announced a proposal to update these guidelines to lower the starting age for screening. This would be an significant change from the last USPSTF breast cancer screening guidelines issued in 2016.
What is the change?
The new USPSTF recommendation lower the recommended age to start screening for breast cancer to 40 years of age in average risk women. However, unlike the ACR and the ACS annual screening recommendation, the USPSTF will recommend that mammograms be done every 2 years and not annually.
Certain exceptions apply if patients are at higher risk, for which experts recommend additional screening in these situations:
- High Risk Genetics. The recommendation is not appropriate for those with genetic markers or syndromes that increases the risk of breast cancer.
- Previous radiation treatment. It is also not the right course of care of those with a history of radiation therapy to the chest.
- Previous Cancer or Precancerous Biopsy. A different plan is best for those with a previous breast cancer diagnosis or history of high-risk breast lesions.
Why the change?
Experts believe advances in treatment and diagnosis for younger women with breast cancer at a younger age will reduce the mortality rate. This is particularly true when it comes to breast cancer in Black women. Black women are at higher risk of aggressive breast cancer at younger ages and these preventative measures could help with early identification and treatment.
The data also supports the change. The rate of breast cancer diagnosis increased by 2% from 2015 to 2019. This signals the need for a change — a change experts believe the lowered screening age will help address. A change supported by the fact that early screening can reduce the mortality rate by up to 40%.
The change to USPSTF guidelines will put the organization in line with many current clinical practices which already often screen at age forty. The more organizations that are on the same page, the higher the likelihood that women will get the screening services they need to increase the risk of successful treatment for this devastating disease.
There is a positive relationship between the age at screening and the ability to detect early cancers in the breast. Breast cancer is generally dense like normal glandular tissue and is more difficult to detect in younger breasts that still have a lot of milk glands and ducts, as these structures appear as various shades of white. As women age, the glandular issue is replaced by fatty tissue, which is less dense and appears dark on mammograms. Small whitish cancers appearing on a black background are more easily seen and detected in an older woman’s breast. Conversely, small cancers when imaged by mammography in young women are harder to diagnose because the more glandular tissue present, the more white background obscures them.
Is it enough?
Critics argue that the USPSTF’s proposal is a good start, but more is needed. Examples include:
- Black women. As noted above, Black women are more likely to get aggressive breast cancers at a younger age. Medical professionals are calling on the organization to push forward education and risk assessment for black women before they reach age thirty.
- More frequent screening. Instead of biannual screening, experts are calling for annual screening after forty.
- Expansion to cut off age. Quality of life for women in their eighties and nineties is not what it once was. More women are enjoying a high quality of life during these ages. This has led experts to call on the USPSTF to push the cut off age back past the currently recommended age of seventy-four.
- Dense tissue. Those with dense breast tissue are at a higher risk for breast cancer as it is more difficult to identify the disease. Additional screening may help address this problem.
It is important to highlight that the USPSTF’s proposal is just that: a proposal. They are taking comments and will decide to implement the current proposal or make additional changes in coming months. Regardless, the discussion is an important one that highlights the need for physicians to stay current on changes in their field as these changes directly impact the diagnosis and treatment of patients with serious, life-threatening diseases.