USPSTF: Screen for breast cancer every other year starting at age 40

Key takeaways:

• The USPSTF now recommends biannual breast cancer screening for women aged 40 to 74 years.
• There was insufficient evidence to draw conclusions on supplemental screening for women with dense breasts.

All women aged 40 to 74 years should be screened for breast cancer every other year, according to a draft recommendation statement from the U.S. Preventive Services Task Force.

The B grade recommendation updates the task force’s 2016 recommendation, which said women in their 40s should make individual decisions about when to start screening.

Although no trials compared annual vs. biennial screening, when considering lives saved against harms like unnecessary follow-up and treatment, the task force concluded that women benefit more when screening is done every other year.

John B. Wong, MD, a member of the task force, told Healio that “screening for breast cancer saves lives.”

“We now have new and more inclusive science that enables us to expand our prior recommendation and encourage all women to get screened every other year starting at age 40,” Wong said. “This new approach has the potential to save nearly 20% more lives and has even greater potential benefit for Black women, who are much more likely to die from breast cancer.”

Among women in the U.S., breast cancer is the second-most common cancer and the second-most common cause of cancer death; an estimated 43,250 women in the U.S. died of breast cancer in 2022.

The recommendation does not apply to those with a personal history of breast cancer, those who had a lesion on previous biopsies and those who have a very high risk for breast cancer because of a history of high-dose radiation therapy to their chest at a young age or certain genetic markers.

The USPSTF also released two I draft recommendation statements. The task force concluded that there is not yet enough evidence to determine:

• if women with dense breasts should have additional screening with breast ultrasound or MRI; and
• the benefits and harms of screening in women aged older than 75 years.

“Nearly half of all women have dense breasts, which increases their risk for breast cancer and means that mammograms may not work as well for them,” Wong said. “We need to know more about whether and how additional screening might help women with dense breasts stay healthy. We also need evidence on the benefits and harms of screening in women who are 75 and older.”

The task force also called for more research on what can be done to eliminate health disparities.

Black women are 40% more likely to die from breast cancer than white women, according to the USPSTF.

“Screening for breast cancer in Black women at age 40 is an important first step, but it is not enough to improve these inequities,” Wong said. “It’s important that health care professionals involve patients in a conversation on how best to support them after screening to ensure timely follow-up, as well as effective and equitable treatment of breast cancer.”

The American Cancer Society (ACS) said in a statement that “the main change in the USPSTF recommendation, which only applies to average-risk women, is lowering the age to begin biennial screening from age 50 to age 40.”

“We applaud the return in USPSTF recommendations to begin screening in their 40s,” William L. Dahut, MD, chief scientific officer for ACS, said in the statement. “However, further consideration may be required as to the frequency of screening for women under age 55. Current evidence indicates that biennial screening in this population is associated with a diagnosis of more advanced disease.”

In its own guidelines, ACS recommends that women decide about beginning screening at age 40 years, but by age 45 years, the society recommends annual screening.

In addition, for women aged older than 74 years, ACS said it recommends that women “continue screening as long as they are in good health and are expected to live at least 10 more years.”

“The ACS believes health and life expectancy, not simply age, must be considered in screening decisions, as spelled out in our current guideline,” Dahut said.

Public comment on the USPSTF draft recommendations is open through June 5. To submit comments, click here. 

References:

• American Cancer Society statement: American Cancer Society supports lowering of the age of screening commencement in updated USPSTF breast cancer screening recommendation. http://pressroom.cancer.org/releases?item=1214. Published May 9, 2023. Accessed May 9, 2023.
• Draft recommendation statement. https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/breast-cancer-screening-adults. Published May 9, 2023. Accessed May 4, 2023.
• Screening for breast cancer: A comparative effectiveness review for the U.S. Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/. Published May 9, 2023. Accessed May 4, 2023.
• Task force issues draft recommendation statement on screening for breast cancer. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/breast-cancer-screening-draft-rec-bulletin.pdf. Published May 9, 2023. Accessed May 4, 2023.