May 9, 2023 – Women should start breast cancer screening as early as age 40 relatively than waiting until age 50, the U.S. Preventive Services Task Force said in a draft suggestion on Tuesday.
The key change within the age for mammograms also includes the suggestion for screening every two years and sets a maximum age of 74 years.
The task force's rating system shows high confidence within the evidence of the advantages of the changes, which implies doctors should encourage their patients to undergo the essential tests.
The influential federal advisory committee last updated these recommendations in 2016. At that point, the duty force beneficial routine screening mammograms starting at age 50.
In the 2016 recommendations, “we felt that a woman could begin screening in her 40s based on her individual personal decision-making judgment about the risks and benefits,” said task force member John Wong, MD, chief of clinical decision-making and a primary care physician at Tufts Medical Center. “In this draft recommendation, we now recommend that all women be screened starting at age 40.”
Two essential aspects are chargeable for this transformation, Wong said. One is that more women are being diagnosed with breast cancer of their 40s. The other is that a growing variety of Show evidence Black women develop breast cancer earlier, die from breast cancer more often, and would profit from earlier screening.
“It is now clear that screening every two years starting at age 40 has the potential to save about 20% more lives among all women, and there is an even greater potential benefit for black women, who are much more likely to die from breast cancer,” Wong said.
The American Cancer Society called the draft suggestion a “significant positive change,” but noted that the duty force's recommendations apply only to women at average risk for breast cancer.
The American College of Radiology already recommends annual mammograms for girls with average risk from the age of 40. latest guidelines on mammographypublished on May 3, urge women at above-average risk of breast cancer to undergo a risk assessment by age 25 to find out whether screening before age 40 is essential.
Asked concerning the differing views, Dr. Debra Monticciolo, division chief of breast imaging at Massachusetts General Hospital, said annual screenings would save more lives than the biennial approach supported by the duty force. Monticciolo also said the available science supports earlier assessment, in addition to screening before age 40 for many ladies, particularly black women.
“These evidence-based updates should lead to better-informed doctor-patient conversations and help providers save more lives,” Monticciolo said in a Press release.
Insurance access
Typically, upgrading a Task Force suggestion from a C to a B will lead to higher access and coverage for patients. The Affordable Care Act requires insurers to cover the costs of services that receive A and B recommendations with none additional payments – a requirement that is meant to encourage greater use of highly regarded services.
But Congress created a special workaround that makes the Affordable Care Act provision applicable to the Task Force's 2002 recommendations on mammography. In those recommendations, the Task Force gave a grade of B for screening mammograms each one or two years starting at age 40 with no age limit.
Federal lawmakers have attempted to supply copayment-free access to mammograms for this complete population, regardless that the Task Force's 2009 and 2016 recommendations gave routine screenings for girls under 50 a C rating.
Still, “it is important to note that our recommendation is based solely on scientific evidence about what helps prevent breast cancer and is not a recommendation for or against health insurance,” the duty force acknowledged when presenting the brand new draft. “Decisions about health insurance must include considerations that go beyond the evidence of clinical benefit, and ultimately these decisions are the responsibility of payers, regulators and legislators.”
Uncertainties remain
The recent draft suggestion also highlights the continuing gaps in knowledge concerning the use of mammography despite years of widespread use of this screening tool.
The updated draft suggestion highlights the dearth of evidence to deal with vital areas of concern related to the prevention and treatment of black women, older women, women with dense breast growth, and girls with ductal carcinoma in situ (DCIS), also often called stage 0 breast cancer.
The task force called for more research to analyze the underlying causes of the increased breast cancer death rate amongst black women.
“Nearly half of all women have dense breasts, which increases their risk of breast cancer and means mammograms may not work as well for them. We need to know more about whether and how additional screening can help women with dense breasts stay healthy,” the duty force said.
The task force also called for more research into approaches to cut back the chance of overdiagnosis and overtreatment of breast lesions corresponding to DCIS identified through screening.
The Task Force will accept public comments on this draft update until June 5.