May 9, 2023 – Women should start getting screened for breast cancer at age 40 instead of waiting until age 50, the US Preventive Services Task Force said Tuesday in a draft recommendation statement.
The critical change in age for mammograms also includes recommendations for screening every two years and sets a cut-off age of 74 years.
The task force scoring system shows high confidence in the evidence that they will benefit from the changes, which means that clinicians should encourage their patients to be screened as appropriate.
The influential federal advisory panel last updated these recommendations in 2016. At that time, the task force recommended routine screening mammograms starting at age 50.
In the 2016 recommendations, “we feel that a woman could start testing at age 40 depending on how she feels about the harms and benefits in an individualized personal decision,” said task force member John Wong, MD, chief clinical decision maker and primary attending physician at Tufts Medical Center. “In this draft recommendation, we now recommend that all women be tested starting at age 40.”
Two main factors drove the change, Wong said. One is that more women are being diagnosed with breast cancer in their 40s. The other is that a growing body of the evidence shows Black women get breast cancer at a younger age, are more likely to die from breast cancer, and would benefit from earlier screening.
“It is now clear that screening every two years starting at age 40 has the potential to save approximately 20% more lives among all women and there is an even greater potential benefit for black women, who are much more likely to die of breast cancer.” Wong said.
The American Cancer Society called the draft recommendations a “significant positive change,” noting that the task force’s recommendations only apply to women with average risk of breast cancer.
The American College of Radiology already recommends annual mammograms for average-risk women age 40 and older. latest mammography guidelinespublished May 3, call for women with an above-average risk of breast cancer to have a risk assessment before age 25 to determine if screening is necessary before age 40.
When asked about the differing viewpoints, Debra Monticciolo, MD, division chief of breast imaging at Massachusetts General Hospital, said annual screening would save more lives than the biennial approach endorsed by the task force. . Monticciolo also said that available scientific evidence supports earlier screening, as well as screening before age 40 for many women, particularly black women.
“These evidence-based updates should drive more informed doctor-patient conversations and help providers save more lives,” Monticciolo said in a statement. Press release.
access to insurance
Upgrading a task force’s recommendation from a grade of C to B typically leads to better access and insurance coverage for patients. The Affordable Care Act requires insurers cover the cost of services that earn recommendations A and B without charging co-pays, a mandate intended to promote greater use of highly regarded services.
But Congress created a special solution that effectively makes the mandate of the Affordable Care Act apply to the 2002 task force recommendations on mammography. In those recommendations, the task force gave a B rating to screening mammograms every 1 to 2 years starting at age 40 with no age limit.
Federal lawmakers have tried to provide access to mammograms without a copay for this entire population, even as task force recommendations in 2009 and 2016 gave routine screening a C rating for women under age 50.
Still, “it is important to note that our recommendation is based solely on the science of what works to prevent breast cancer and is not a recommendation for or against insurance coverage,” the task force acknowledged. when submitting the new draft update. “Coverage decisions involve considerations beyond evidence about clinical benefit, and ultimately these decisions are the responsibility of payers, regulators, and policymakers.”
Uncertainties persist
The new draft recommendations also highlight persistent gaps in knowledge about the uses of mammography despite years of Widespread use of this detection tool.
The updated draft recommendations emphasize the lack of evidence to address the main areas of concern related to the detection and treatment of black women, older women, women with dense breasts, and those with ductal carcinoma in situ (DCIS), which is also called stage 0 breast cancer.
The task force called for more research to address the underlying causes of the high breast cancer death rates among black women.
“Nearly half of all women have dense breasts, which increases the risk of breast cancer and means mammograms may not work as well for them. We need to know more about whether additional screening might help women women with dense breasts to stay healthy and how”. said the task force.
The task force also called for more research on approaches to reduce the risk of overdiagnosis and overtreatment of breast lesions, such as DCIS, that are identified through screening.
The working group will accept public comments on this draft update until June 5.
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