The U.S. Preventive Services Task Force (USPSTF) officially updated its recommendations this week for who should be screened for breast cancer and when, advising that women should have their first mammogram earlier in life but not going as far as to urge annual exams.
The independent, volunteer group now says all women should get screened every other year, starting after their 40th birthday. The change aims to help reduce the risks of the second most common cancer in the country, which is seeing case counts rise among younger people.
In its most recent prior set of recommendations, the task force said women between the ages of 40 and 50 should make a personal decision when it came to pursuing X-ray mammography or other tests, based on their family health history and preferences.
“More women in their 40s have been getting breast cancer, with rates increasing about 2% each year, so this recommendation will make a big difference for people across the country,” said the task force’s chair, Wanda Nicholson, M.D., a professor of prevention and community health at the George Washington University’s Milken Institute School of Public Health.
“By starting to screen all women at age 40, we can save nearly 20% more lives from breast cancer overall,” added Nicholson, who also serves as the university’s senior associate dean for diversity, equity and inclusion. “This new approach has even greater potential benefit for Black women, who are much more likely to die of breast cancer.”
The task force estimated that more than 43,000 women died due to breast cancer in 2023. White women had the highest incidence rate, with 136.3 cases per 100,000, followed by Black women at 128.3 cases. However, despite similar rates of mammography screening, Black women were more likely to be diagnosed with higher-stage and more aggressive tumors, and are 40% more likely to die of breast cancer compared to white women.
The USPSTF did not make additional specific recommendations for people with dense breast tissue—which can make it harder to detect cancer on a mammogram, and, as a category, includes nearly half of all women. The task force said there is currently insufficient research either for or against an endorsement of extra screening, including with ultrasound or an MRI scan.
“Women deserve to have the best science available to guide them on how to protect their health, and we’re asking the research community to prioritize studies that can show us how best to screen for breast cancer in women with dense breasts,” Nicholson said. “In the meantime, women with dense breasts should talk with their clinician about options for follow-up testing so that they can get the care that’s right for them.”
The task force’s finalized recommendations—which were also published earlier this week in the Journal of the American Medical Association—delivered a “B” rating to mammogram screening every two years between the ages of 40 and 74, including digital 3D mammography.
It offered the same grade in its 2016 recommendations, which had called for biennial screening between ages 50 and 74. However, those guidelines departed from its findings in 2002, which had advocated for screenings every one or two years starting at age 40.
Some felt the current, newly updated guidelines do not go far enough and that the task force should return to its previous ratings.
In an accompanying editorial published in JAMA Oncology, Wendie Berg, M.D., Ph.D., a professor in the department of radiology at the University of Pittsburgh School of Medicine, said annual mammography can be as efficient as biennial exams but bring greater gains in the number of years of life saved.
Berg also cited an analysis of about 600 women who died of breast cancer, with nearly two-thirds having never undergone a screening mammogram, and a median age at diagnosis of 49.
“According to Cancer Intervention Surveillance Modeling Network modeling that informed the USPSTF’s decision, biennial screening among women aged 40 to 74 years should yield a 28.4% breast cancer mortality reduction, compared with 35.2% from annual screening, and an even greater 41.7% reduction from annual screening among women aged 40 to 79 years,” Berg wrote.
“In summary, the updated USPSTF recommendations are an important step forward, but they stop short,” she added. “Annual screening is particularly important for premenopausal women, especially women in racial and ethnic minority groups.”
Those positions were echoed by major players in the imaging industry. In a statement, 3D mammogram maker Hologic said, “We hope this decision will raise awareness about early detection and highlight the critical role that mammograms play in women’s health.
“While this is important progress, we strongly encourage the task force to further strengthen guidelines by recommending that women get screened annually,” the company added. “Annual screening with 3D mammography is the most effective way to identify cancer early and prevent cancer deaths … because when breast cancer is caught early, it is highly treatable and the five-year survival rate is 99%.”
Siemens Healthineers also told Fierce Medtech that it will continue to advocate for annual screening, starting at age 40: “Additionally, we support supplementary and diagnostic breast imaging—breast ultrasonography or magnetic resonance imaging—for women who are classified as being at risk, including women with dense breasts.”
Meanwhile, GE HealthCare said, “While it is encouraging that USPSTF lowered the recommended breast cancer screening age, we had hoped it would acknowledge the importance of supplementary screening technologies in personalized breast care—especially for those with dense breasts. We remain committed to demonstrating the value and benefits of supplemental screening technologies, as well as access to these critical screenings, to help improve breast cancer detection.”
Berg said that many women with dense breasts or a family history of breast cancer may have an elevated lifetime breast cancer risk of at least 20% and would qualify for supplemental MRI screening.
“Furthermore, MRI was found to be cost-effective, prompting the European Society of Breast Imaging to recommend adding screening MRI every 2 to 4 years for women with extremely dense breasts,” she wrote. “Regular risk assessment should commence at age 25 years to identify women at high risk who should start annual MRI screening.”
Meanwhile, starting in September 2024, the FDA will begin requiring that mammography centers inform patients of their breast density following an exam. They will also have to explain that dense breast tissue increases the risk of cancer and makes it harder to detect and that other imaging tests may help.
Editor's note: This story was updated with additional comment from GE HealthCare.