New breast cancer screening guidelines draw praise, and some criticism

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.

Previously, the guidelines suggested women begin regular mammograms at age 50. The task force issued the recommendations Tuesday and cited the disparities among women in minority groups, including Black women.

Under the task force’s new guidance, women between the ages of 40 and 74 should be screened for breast cancer every other year.

While an advisory body, the panel makes recommendations to the federal government and is supported by the U.S. Department of Health and Human Services. The task force is accepting public comment until June 5.

The new guidelines reflect the insights of additional research, says Carol Mangione, the task force’s immediate past chair. The task force estimated that by starting screenings at age 40, the number of lives saved could rise by 19%.

“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,” Mangione said in a statement. “This new recommendation will help save lives and prevent more women from dying due to breast cancer.”

While the task force said nearly half of all women have dense breasts, increasing their risk of breast cancer, the group stopped short of recommending additional screening with breast ultrasound or MRI. The task force said more research is needed.

And the task force said further study is needed on weighing the benefits and risks of screenings in women over the age of 75.

Black women are more likely to die of breast cancer than white patients, and the task force cited that as a factor in adjusting its recommendations to begin regular screenings at age 40.

“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,” Wanda Nicholson, vice chair of the task force, said in a statement.

“In our draft recommendation, we underscore the importance of equitable followup 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,” Nicholson said.

Lola Fayanju, chief of the division of breast surgery at the University of Pennsylvania’s Perelman School of Medicine, said the revised guidelines could save more Black women.

“I cannot emphasize how important this development is,” Fayanju wrote on Twitter. “Black women are more likely to present at younger ages, with more aggressive disease, & at later stage. Now we have a chance to catch these deadly cancers before it's too late.”

The task force also called for more research to close disparities in outcomes for women in minority groups, including Black, Hispanic, Latina, Asian, Native American, and Alaska Native women.

The panel also noted that its recommendations for women applied to cisgender women and other people assigned female at birth.

While many praised the task force for recommending an earlier age to begin screenings, some said the guidelines didn’t go far enough.

In an op-ed for Medpage Today, Nina Vincoff, medical director for the Katz Institute for Women's Health and breast imaging division chief at Northwell Health, says women should be getting mammograms annually.

“Research has shown that yearly mammography starting at age 40 saves more lives -- reducing breast cancer mortality by up to 40% compared to no screening,” she wrote. “Having mammograms yearly, instead of every other year, helps find cancers when they are smaller and easier to treat, which may reduce the need for aggressive treatments, like mastectomy and chemotherapy.”

Vincoff and others criticized the task force for opting against recommending of additional screening for women with dense breasts. “Women with dense breasts and their doctors need guidance about what additional testing they need,” Vincoff wrote. “They won't be able to find that guidance in the USPSTF's proposed recommendations.”

Some are advocating women with higher risks to begin screenings earlier. The American College of Radiology, which has been advocating for annual screenings starting at age 40, said last week that all women should be assessed at age 25 to determine if they should begin screenings before the age of 40.

The American Cancer Society’s guidelines have called for women between the ages of 45 and 54 to have mammograms annually, while women 55 and older could switch to getting screenings every other year if they desire, or continue with annual screenings. The cancer society has said women should continue screenings as long as they remain in good health and are expected to live another 10 years.

Some health systems say screenings for breast cancer, while improved since the height of the COVID-19 pandemic, have yet to bounce back to pre-pandemic levels. Officials at some hospital systems last fall told Chief Healthcare Executive® that they continued to see a decline in the number of women getting checked for breast cancer, even with heightened publicity in October for breast cancer awareness.