New breast cancer screening guidelines: Questions and answers

Women should begin getting screened for breast cancer at the age of 40, according to new guidelines from the U.S. Preventive Services Task Force.

The task force released draft recommendations last year, and published the finalized recommendations this week.

Here’s a quick overview of the recommendations, and where they have garnered praise and some criticism.

What’s the significance of saying screenings should begin at age 40?

It’s a significant change from the task force’s earlier guidance. Previously, the task force said regular screenings should begin at age 50.

Wanda Nicholson, MD, chairwoman of the task force, said more women in their 40s are getting breast cancer, “so this recommendation will make a big difference for people across the country.

“By starting to screen all women at age 40, we can save nearly 20 percent more lives from breast cancer overall,” Nicholson said in a statement. “This new approach has even greater potential benefit for Black women, who are much more likely to die of breast cancer.”

Breast cancer was the most common cancer among those under the age of 50, according to a study published in August 2023 by Jama Network Open. Breast cancer is also the leading cause of cancer deaths among women under 50.

• Read more: ‘Cancer care is different’” Calling for better access and treatment

Do the guidelines call for annual screenings?

No, and that’s a point of contention for some healthcare leaders.

The task force recommends that women should get screened every other year at age 40.

Nina Vincoff, the chief of breast imaging at Northwell Health, told Chief Healthcare Executive® in an October 2023 interview that recommending screenings to start at age 40 is an important step. But she thinks screenings should be done annually.

“When we screen every year, we increase the chances that we're going to find breast cancers when they're smaller and easier to treat,” she said.

The American College of Radiology issued a statement this week saying that women with an average risk of breast cancer should start annual screenings at age 40. The ACR said women with higher risk should ask their doctors about starting screenings earlier, and said women should get breast cancer risk assessments at age 25.

Is there a maximum age for screenings in the task force recommendations?

Women should continue annual screenings until the age of 74, the task force says. The task force says more research is needed to evaluate the risks and benefits for screenings over the age of 75.

Some physicians disagree with the task force on that point, noting that some women remain healthy and active well after the age of 75.

Brett Roberts, head of breast radiology at Ochsner Health, told Chief Healthcare Executive® in October that he suggests recommendations should be tailored to individual patients.

“If it seems like they're going to have a good five to seven years of life ahead of them, they'd benefit from a screening mammogram,” Roberts said.

Do the guidelines offer recommendations for women with dense breasts?

The task force notes that almost half of all women have dense breasts, putting them at greater risk for breast cancer. But the task force didn’t specify recommendations for such women.

“Unfortunately, there is not yet enough evidence for the task force to recommend for or against additional screening with breast ultrasound or MRI,” the task force said. “We are urgently calling for more research on whether and how additional screening might help women with dense breasts find cancers earlier.”

U.S. Rep. Rosa DeLauro, D-Conn., criticized the lack of guidance for women with dense breasts.

“Because of the Task Force’s failure to issue a recommendation that would ensure women have these additional screenings covered, I fear women may forgo these screenings entirely if their insurance does not cover it,” DeLauro said in a statement. “This threatens the health outcomes of women and in the worst cases, their lives.”

The Food and Drug Administration has adopted new regulations requiring providers to notify women who get mammograms if they have dense breast tissue, which increases the risk of breast cancer. Healthcare leaders say that’s an important step that could help more women identify cancers.

Are there more specific guidelines for Black women?

The task force notes that Black women are 40% more likely to die of breast cancer, so suggesting earlier screenings could help improve outcomes and reduce inequities.

The task force doesn’t outline more specific guidelines for Black women. But the task force said it is “urgently calling for more evidence to better understand whether Black women could potentially be helped by different screening strategies.”

John Wong, MD, the vice chair of the task force, said that more must be done to reduce disparities in treating breast cancer.

“Clinicians must help reduce any barriers to patients getting the recommended screening, timely, equitable, and appropriate follow-up, and effective treatment of breast cancer,” Wong said in a statement.

• Read more: Black patients have higher mortality in most cancers, and gaps persist at higher incomes

What are other reactions to the guidelines?

In an editorial published April 30 by Jama Network Open, Lydia Pace, MD, and Nancy Keating, MD, write that “there is still a role for individualized risk assessment and shared decision-making in breast cancer screening.”

Health systems and insurers are likely to establish screening at age 40 as a benchmark. But they call for a different approach.

“We suggest that health systems should instead measure receipt of high-quality shared decision-making about breast cancer screening starting at age 40 years,” they wrote. “They should also measure equity in breast cancer evaluation, treatment, and outcomes.”