A national task force has lowered the recommended age to begin screenings, but doctors say some opportunities to help more women are being missed.
Over the past year, doctors have hailed significant strides in the fight against breast cancer.
“In some ways, this has been a really great year for breast cancer awareness,” says Nina Vincoff, the chief of breast imaging at Northwell Health.
After much effort from advocates, the U.S. Preventive Services Task Force said women should begin getting screened for breast cancer at the age of 40. Previously, the task force said women shouldn’t start regular mammograms until the age of 50. The task force also made note of the higher risks of breast cancer among Black women.
In addition, 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.
Both developments deserve more attention, doctors say. At the same time, physicians say they would like to see changes in recommendations regarding screenings for women, both in terms of frequency and for older patients. They also acknowledge that there is still work to do to improve messaging to vulnerable populations, particularly Black women.
One in eight women will get breast cancer in her lifetime, officials say. Breast cancer death rates have dropped more than 40% since 1989, according to figures from the American Cancer Society.
Still, Brett Roberts, head of breast radiology at Ochsner Health, says too many women are losing their lives to breast cancer.
“Unfortunately, breast cancer remains all too common in our country and in the world. And unfortunately, breast cancer mortality remains all too common,” Roberts says.
“Breast cancer is a treatable disease,” Roberts says. “It's a curable disease, and early detection matters.” (In this video, Brett Roberts of Ochsner Health talks about the importance of breast cancer screenings. The story continues below.)
Most physicians and advocates cheered the U.S. Preventive Services Task Force for recommending that women should begin screenings at age 40. Critics had long said screenings should begin earlier than age 50, as the advisory body had previously recommended.
“I think that's a really positive and important development,” Vincoff says. “You know, we're now going to have a decade more opportunity to find cancers when they're small.”
“I think it's a really important step in the right direction for women in their 40s to be advised to have screening,” she continues. “About one-sixth of all breast cancers happen in women who are under 50.”
Breast cancer is the most common cancer among those under the age of 50, according to a study published in Jama Network Open in August. Researchers found a 7.7% increase in early-onset breast cancer - those diagnosed under the age of 50 - from 2010 to 2019.
Many physicians have expressed their disappointment that the task force said women should get mammograms every other year. Doctors argue that women should be screened every year.
Vincoff is among those who say women should get mammograms once a year and wanted to see the task force make that recommendation.
“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 says.
Roberts says the task force made an important step in advising that mammograms should start at age 40, but he also thinks the panel made a mistake in saying screenings can be done every two years.
“There's scientific proof that lives are cost by going every other year with screening mammograms,” Roberts says. “And the unfortunate reality is that we're going to lose women to breast cancer, because they only screen every other year.”
Beyond helping women survive breast cancer, doctors say helping women get diagnosed earlier through annual mammograms can help them avoid more invasive procedures.
“If we're able to find cancers when they're smaller and maybe avoid the need for aggressive chemotherapy or mastectomy, that's just as important, I think, as ultimately, the number of lives saved,” Vincoff says.
The American College of Radiology has been advocating for annual screenings starting at age 40. But the organization also says that all women should have a risk assessment at age 25 to determine if they should begin screenings before the age of 40. The group said it’s particularly important for Black and Ashkenazi Jewish women to have risk assessments done at age 25.
The task force noted that Black women with breast cancer have a higher mortality rate, and that was a factor in recommending screenings should begin at age 40. Even though Black women are slightly less likely than white women to develop breast cancer, the mortality rate among Black women is 40% higher than white women, the American Cancer Society says.
“We're increasingly recognizing that Black women, in particular, tend to get breast cancers younger and tend to have those cancers be more aggressive,” Vincoff says.
Some physicians also would have disagreed with the task force advising regular mammograms in women only until the age of 74. Doctors note that some women beyond the age of 74 could have years ahead of them.
“Women are living long and productive lives, well into their 80s and 90s,” Vincoff says.
Roberts suggests guidance for older patients should be tailored to the health of the patient.
“We feel we should base it on the patient,” he says.
“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 says.
A ‘game changer’
Doctors say women at risk of breast cancer will also benefit from new federal regulations requiring providers to tell patients if they have dense breast tissue.
The FDA announced the new rule earlier this year and it will be fully implemented next year.
Half of American women have dense breasts, which gives them a greater risk of developing breast cancer. In addition, mammograms have more difficulty detecting cancers in dense breasts.
Vincoff says this new regulation’s impact can’t be overstated. More women will get better information and be able to pursue more advanced screening that could detect cancers earlier.
“I think it is a game changer because half of American women have dense breasts and I think need to be aware of the fact that this is putting them at increased risk,” she says.
Patients will be told if they have dense breast tissue in letters about their mammogram results, and it will be in plain language.
“I think allowing women to be able to have that information and to advocate for themselves about the additional screening that they might need, I do think that's a game changer,” Vincoff says. “That's empowering.”
Even as October has been designated as a month to raise breast cancer awareness, Vincoff says it’s time to expand education. She says it’s time for a focus on “empowerment.”
Specifically, she’d like to see more efforts on educating women about screening guidelines, and proactive steps women can take to stay healthy and reduce their risks of breast cancer, such as getting more exercise, maintaining a healthy weight and limiting alcohol intake. Vincoff also says she would like to see more attention to helping women understand changes in their body that should prompt them to visit their doctor.
Physicians also stress that women need to maintain annual mammogram schedules. They urge women to avoid putting off their screenings.
“Finding it earlier leads to better, more comprehensive, treatment,” Roberts says. “It saves lives and care now is better as well.”
While women may be nervous about the results, or even the procedure itself, Vincoff suggests women focus on the positive step they are taking for themselves.
“I totally understand that it is scary to have this kind of testing,” Vincoff says. “What I would say to women is, flip it around and think of it as empowering. Think about it as something that you're doing to ensure that you're going to be there to have a long healthy life, both for yourself and for the people that love you.”