The U.S. Preventive Services Task Force issued new breast cancer screening recommendations on Tuesday, now urging all women to begin undergoing screening every other year starting at age 40.
Its draft guidelines mark a shift from the USPSTF’s previous standards, which endorsed screening starting at age 50. Vendors in the women’s imaging space such as Hologic and iCAD saw their stock prices rise sharply Tuesday morning following the news, with screening volumes expected to swell.
The influential USPSTF had previously urged women to “make an individual decision” on when to begin screening prior to 50, but now is reversing course and matching guidelines outlined by medical societies.
“New and more inclusive science about breast cancer in people younger than 50 has enabled us to expand our prior recommendation and encourage all women to get screened every other year starting at age 40,” task force immediate past Chair Carol Mangione, MD, said in a May 9 announcement. “This new recommendation will help save lives and prevent more women from dying due to breast cancer.”
Meanwhile, the group said more research is needed on whether women with dense breasts should have additional screening with ultrasound or MRI. Same for the benefits and harms of screening women older than age 75, according to the draft recommendations. Experts with the task force also highlighted inequities in cancer care. Black women, in particular, are 40% more likely to die of the disease, which is the second leading cancer-killer in America. USPSTF is advocating for additional research to better understand this gap.
“Ensuring Black women start screening at age 40 is an important first step, yet it is not enough to improve the health inequities we face related to breast cancer,” task force Vice Chair Wanda Nicholson, MD, MBA, added in the announcement. “In our draft recommendation, we underscore the importance of equitable follow-up after screening and timely and effective treatment of breast cancer and are urgently calling for more research on how to improve the health of Black women.”
The draft recommendations pertain to women at average risk of breast cancer, including those with a family history or dense breasts. However, it does not apply to women with a personal history of breast cancer, nor those at “very high risk” because of genetic markers. USPSTF is accepting comments on the document until June 5.
The American College of Radiology and Society of Breast Imaging called the new recommendations a “step in the right direction.” But they believe all women at average risk should undergo annual mammograms starting at 40, rather than every other year.
“The USPSTF, ACR, SBI, American Cancer Society and others all agree that the most lives are saved with this annual approach. Medical experts should clear the confusion caused by differing recommendations and agree to recommend yearly mammography for average-risk women starting at age 40,” the two groups said in a joint statement issued Tuesday.
ACR released its own new breast cancer screening guidelines last week. The college and SBI additionally believe that all women should undergo risk assessments for the disease by age 25. This includes determining whether imaging via ultrasound or MRI are needed. And they emphasize the need for continued screening past age 74, “unless severe comorbidities limit life expectancy.”
Along with Black and Ashkenazi Jewish women, the two imaging societies highlighted need for vigilance among transgender populations. This includes biological males transitioning to female, who are at greater risk of developing the disease.
“Involving factors such as sex assigned at birth, hormone use and surgical histories place transgender persons at increased risk for breast cancer. Biological females transitioning to male who do not undergo mastectomy remain at their previous risk for breast cancer and should continue to be screened as such,” the two said in their statement.
USPSTF is an independent, volunteer panel of experts in medicine that makes recommendations on preventive services such as screening. Its recommendations also directly influence payment polices among both commercial and governmental insurers such as Medicare and Medicaid.