Age 40 should be the new recommended starting age for breast cancer screening, a group suggests

In the course of their lives, 1 in 8 women will acquire breast cancer. Outside experts are concerned that the new draft guidelines don’t go far enough in lowering the age for mammograms.

According to draft recommendations announced on Tuesday by the United States Preventive Services Task Force, the independent national panel of experts that establishes standards for examinations and screenings, women should begin getting checked for breast cancer every other year at age 40 rather than 50.

Previous advice, which was most recently updated in 2016, stated that women under 50 who were worried might talk to their doctors about screening. According to the task commission, screening at age 40 might now save 19% more lives.

The suggestions, according to experts, are a step in the right direction but should recommend that women get examined annually. Starting at age 40, numerous other reputable organizations have long advised yearly mammograms.

Dr. Maxine Jochelson, a radiologist at Memorial Sloan Kettering Cancer Center, asserted that cancers do advance in between mammograms. For women with average risk, starting tests at age 40 is the “right answer.”

Every year, approximately 30% of new cancer cases in American women are breast cancer, and it’s predicted that 1 in 8 women will get the disease at some point in their lives. The average age of diagnosis for all women is 62, but racial differences may exist.

Clinicians who treat breast cancer have long advocated for reducing the recommended age for a woman to receive her first mammogram, particularly for Black women who are 40% more likely to die from breast cancer than white women and are more likely to be identified at an earlier age or with aggressive subtypes.

Black women should undergo breast cancer screenings earlier than other women, according to a research.

A kind of breast cancer that develops and spreads more quickly, is challenging to cure, and lacks three receptors frequently identified in breast tumors that doctors target for treatment, over 1 in 5 Black women with breast cancer are diagnosed with triple-negative breast cancer.

As part of its recommendations, the task force is “also calling for more research on how to best address health disparities across screening and treatment,” task force member and internist Dr. John Wong, who also serves as the division chief for clinical decision making at Tufts Medical Center, told USA TODAY.

Although Asian and Pacific Islander women have the lowest breast cancer death rates of any demographic, breast cancer is also the second-leading cause of cancer-related death among white, Asian, Pacific Islander, American Indian, and Alaska Native women.

After the task group evaluates comments received during the June 5 public comment period, the guidelines will become official. Women who were born with the gender assigned to them, transgender men, and nonbinary people are all included by the suggestions.

Why experts claim the updated recommendations still need improvement

The majority of organizations, including the American College of Radiology, the American Society of Breast Surgeons, and the American College of Obstetricians and Gynecologists, advise annual mammograms beginning at age 40.

However, many primary care physicians rely on the task force as the recognized authority for preventative testing. Its recommendations are backed by the federal Agency for Healthcare Research and Quality and are based on an analysis of the available data.

Although the Centers for Disease Control and Prevention states that most insurance plans are mandated to provide mammograms beginning at age 40, private insurance plans typically base coverage on the task force’s recommendations.

In announcing the new draft guidelines, the task force said it chose to keep the recommendation at every other year because of an increased risk of false positives diagnosis. It said that callbacks could frighten patients or prompt pointless biopsies.

But according to specialists, the risks of undetected tumors outweigh this concern, and false positives may be addressed with sophisticated imaging and biopsies.

The American Society of Breast Surgeons member and chief of breast surgery at Rutgers Cancer Institute of New Jersey, Dr. Michele Blackwood, expressed her concern about the guidelines. “The majority of us in this field continue to vehemently support annual mammograms for women over 40.”

According to Blackwood, aggressive malignancies are more common in patients under 50, and because many women avoided mammograms during the COVID-19 pandemic, they are being discovered at a later stage. It’s time, she declared, “to focus on harms of not screening.”

In order to establish whether a mammogram is necessary before the age of 40, the American College of Radiology also advises high-risk groups, such as Black women and Ashkenazi Jewish women, to receive risk assessments by the age of 25.

Dr. Vivian Bea, a breast surgeon at Weill Cornell Medicine and the section chief of breast surgery oncology at NewYork-Presbyterian Brooklyn Methodist Hospital, noted that there is a need for unified guidelines.

“It’s confusing for physicians and providers who are then counseling patients,” she said. Patients find it to be confusing as well.

An oncologist, or cancer specialist, could be beneficial to the Preventative Services Task Force, according to Dr. Ryland Gore, a breast surgery oncologist in Atlanta.

According to estimates, 300,000 new instances of breast cancer will be discovered this year, but the overall number of cases is not decreasing, according to Gore. “Consider how many you might miss if you say, ‘Oh, you can just do this every other year.’ That is insufficient.

“A national emergency”: Black women are 40% more likely than white women to die from breast cancer.

How about breast volume?

When a person has thick breasts, which implies their breasts contain more fibrous tissue than fatty tissue, cancer may go undetected. Breast cancer risk is increased by the fact that nearly half of all women have thick breast tissue.

Experts say mammograms may miss tumors in people with dense breasts and that they may be better detected by ultrasound or MRI. But in its draft guidelines, the task force concluded “that the evidence is insufficient to determine the balance of benefits and harms of supplemental screening for breast cancer with breast ultrasound or MRI, regardless of breast density.”

According to Jochelson, dense breasts make it more difficult to detect cancer on a mammography. Therefore, if you miss it on the mammography, you can detect it on the subsequent mammogram. However, it will have a year to grow.

According to a meta-analysis of 22 studies published in the journal Radiology in January, MRI was the best supplemental imaging in women with thick breasts who had average to intermediate risk for breast cancer and whose mammograms were cancer-free. 541 malignancies missed by mammography in more than 132,000 women with thick breasts were found using alternative imaging.

At least 38 states had legislation in place as of 2019 requiring doctors to tell their patients if they had thick breasts. The U.S. Food and Drug Administration, which oversees mammography laws, revised its rules in March to compel mammography facilities to notify patients if they have thick breasts.

By performing yearly and supplemental imaging, Jochelson claimed that “we can save more lives.” “I have no doubts at all.”

Black women are missing from breast cancer tumor data. And that could be what’s killing them.

Native American women with breast cancer must contend with long distances and little options.

breast cancer risk factors

Risk factors, according to the CDC, include:

strong breast tissue. This increases the risk of breast cancer and can make it harder to see a tumor by mammogram. Ask the mammographer to let you know if you have dense breast tissue, and if so, talk to your doctor about if additional imaging tests like an ultrasound or an MRI are advised.
Family background. A first-degree relative, such as a mother, sister, or daughter, or several relatives on either the maternal or paternal side, who have had breast or ovarian cancer, are at a higher risk.
Age. The risk of breast cancer rises with age.
genetic changes. Breast and ovarian cancer risk is increased in people who have inherited gene mutations like BRCA1 and BRCA2.
earlier history. The likelihood of receiving a second breast cancer diagnosis increases with prior diagnoses.

There are risk factors that can also be diminished, according to the CDC. These include sedentary lifestyles, being overweight or obese, using specific menopause-related hormone replacement therapies, specific oral contraceptives, and drinking alcohol.