A national advisory panel has reduced the recommended age for breast cancer screening, suggesting women get their first mammogram at age 40 instead of 50 and continue every other year until age 74.
The U.S. Preventive Services Task Force recommendation comes as more women are being diagnosed with breast cancer at a younger age. It is a reversal of the panel’s previous recommendation suggesting women make an individual choice about getting a mammogram between ages 40 and 49. The recommendation applies to women at average risk of breast cancer, as well as those with a family history of breast cancer and those with dense breasts.
“More women in their 40s have been getting breast cancer, with rates increasing about 2 percent each year, so this recommendation will make a big difference for people across the country,” Task Force Chair Dr. Wanda Nicholson said in a press release. “By starting to screen all women at age 40, we can save nearly 20 percent more lives from breast cancer overall.”
Mortality Rates Declining, but Breast Cancer Rates Increasing
According to the American Cancer Society, breast cancer is the second leading cause of cancer death for women in the United States, despite a steady decline in breast cancer mortality over the past 20 years. Most cases occur in women between the ages of 55 and 74, with the highest death rates occurring in women with a median age of 70.Along with younger women, the new guidelines aim to help black women, who are 40 percent more likely to die of breast cancer than white women, according to Dr. Nicholson, who added that the new guidelines are just another step toward improving existing inequalities in the American health care system.
More Room for False Positives?
Adding another decade of testing increases the risk of experiencing at least one false positive during a mammogram, according to a 2022 University of California (UC)–Davis Health study published in JAMA Network Open. The study found that half of all women will experience at least one false positive over a decade of annual breast cancer screening. However, the risk of a false positive was considerably lower if screening occurred every other year (as recommended by the U.S. Preventive Services Task Force) as opposed to annually over a decade.
False positives are also more likely for women with denser breast tissue. The task force noted that more research is needed to show how screening with breast ultrasound or MRI might better help women with dense breasts.
“Findings from our study highlight the importance of patient-provider discussions around personalized health. It is important to consider a patient’s preferences and risk factors when deciding on screening interval and modality,” Michael Bissell, co-first author of the UC Davis Health study, said in a 2022 news release.
False positives are common. Although only 12 percent of 2D screening mammograms require more testing, less than 1 percent result in a cancer diagnosis, according to the UC Davis press release. Not only can they be expensive and timely, but they can also cause the patient to undergo unnecessary stress.
“Despite the important benefit of screening mammography in reducing breast cancer mortality, it can lead to extra imaging and biopsy procedures, financial and opportunity costs, and patient anxiety,” Diana Miglioretti, professor and division chief of biostatistics at UC Davis’ Department of Public Health Sciences, said in the 2022 press release.
