Global Courant 2023-05-09 20:00:41
Women should be screened for breast cancer every two years starting at age 40, according to the draft guideline released Tuesday by the U.S. Preventive Services Task Force.
That’s earlier than the independent panel of experts had previously recommended: The latest guideline, from 2016, suggested biennial screenings starting at age 50, but noted that women in their 40s could talk to their doctors about screening, especially if they had a family history of breast cancer. Screenings usually involve a mammogram, which is an X-ray of the breast.
The change is the result of new scientific evidence, the task force said. Breast cancer rates among women aged 40-49 increased on average by 2% per year between 2015 and 2019, according to the National Cancer Institute.
The task force estimated that the new recommendations could prevent at least one additional death from breast cancer for every 1,000 women.
“With our new recommendation, it saves 20% more lives across the board for all women,” said Dr. Wanda Nicholson, vice chair of the task force.
She added that the recommendation does not apply to women with a personal history of breast cancer, those who have had an abnormality on a previous biopsy, women who have been exposed to chest radiation at a young age, or women who have a genetic marker for breast cancer. breast cancer, which may need to be screened more often.
But many radiologists feel the recommendations don’t go far enough.
“They’re taking a step in the right direction, but I worry about the timing every other year,” said Dr. Melissa Durand, an associate professor in the Yale School of Medicine Department of Radiology and Biomedical Imaging.
“Annual screening will catch most cancers when they are at their smallest and when treatment can be most effective,” she said. “We’ll miss cancers if we screen every two years.”
Many other medical groups already recommend annual exams before age 50, including American Cancer Society and the American College of Radiology, which recommends annual screenings starting at age 40.
In 2019, about 60% of women were between the ages of 40 and 49 reported having a mammogram in the past two years, according to the Centers for Disease Control and Prevention.
“We disagree with the US task force in so many ways,” said Dr. Stamatia Destounis, chair of the American College of Radiology’s Breast Imaging Commission.
The group issued guidelines last week recommend that all women by age 25 have a conversation with their doctor to determine if they should be screened earlier in life. It also recommended that women with dense breasts, a breast cancer diagnosis before age 50, or a personal history of breast cancer get an MRI every year.
Durand said most radiologists follow the recommendations of the American College of Radiology. But primary care physicians can look to the task force to know when to refer patients for mammograms, and insurers often follow the panel’s recommendations to determine what costs to cover.
Currently, insurance companies cover annual mammograms for women who want them, but some radiologists worry that this could change.
Concerns about missed cases among black women and those with dense breasts
According to dr. Phoebe Freer, chief of breast imaging at the University of Utah’s Kathryn F. Kirk Center for Comprehensive Cancer Care and Women’s Cancers, a screening every two years won’t do much to reduce differences in breast cancer outcomes.
Black women are 40% more likely to die from breast cancer than white women.
Nicholson said much of that disparity is due to inequalities in the health care system, such as a lack of timely follow-up after screenings or unequal access to treatment. But the task force ultimately determined that the risks of annual mammograms — including false positives and unnecessary imaging or biopsies after a scan — outweighed the benefits, she said.
Radiologists also questioned why the task force doesn’t recommend annual screening for women with dense breasts, which make it more difficult to detect cancer.
“If you have a mammogram and it shows that you have dense breast tissue, you should get a mammogram every year and you should have some form of additional screening, whether it’s by ultrasound or MRI,” Durand said.
Nicholson said the task force “searched really deep” for evidence that women with dense breasts needed separate guidelines but couldn’t find them.
Radiologists say annual screenings carry few risks
While the task force’s recommendations weigh the benefits of detecting cancer against the risks of annual scans — including radiation exposure and unnecessary biopsies — radiologists consider those risks relatively small.
Durand said the advanced mammogram technology now widely used is unlikely to show a false positive. And only about 1-2% of women who get screened end up needing a biopsy, Freer said.
She added that whether women are screened annually or biennially, doctors are likely to discover abnormal growths that are not cancerous.
Most women, Freer said, “are willing to risk being called back for additional imaging only to be told they’re fine.”
