Proposed USPSTF guideline update: Advocating for earlier breast cancer screening at age 40

Pop Quiz: At what age do medical experts recommend women of average risk for breast cancer begin receiving screening mammograms?

40
45
50
All of the above.

If you answered “D,” you are correct. Confused? I don’t blame you. Medical societies and independent task forces do not agree on when to begin or end screening mammograms for women at average risk of developing breast cancer. This has led to confusion and frustration. But there is something that we as women can do about it.

The United States Preventive Services Task Force (USPSTF) recently proposed an update to its guidelines that would begin to close the yawning gap between recommendations. People have until June 6 to submit their comments about the proposal, and it is my hope that anyone who has been touched by breast cancer takes the time to review the guideline shift.

For context: The American Society of Breast Surgeons (ASBrS), the American Congress of Obstetricians and Gynecologists (ACOG), the American College of Radiology (ACR), and the National Comprehensive Cancer Network (NCCN) all recommend women should begin screening mammograms starting at age 40.

Meanwhile, the American Cancer Society’s guidelines call for women to begin annual screening at 45 and then get screened every two years starting at 55.

And in a highly controversial move in 2009, the USPSTF declared that women should not be screened until age 50, unless they are high-risk or opt for a more aggressive screening schedule.

These disparate recommendations have left women rudderless as they try to navigate their own well-being. Nationwide, breast cancer cases among women in their 40s rose 2 percent per year between 2015 and 2019.

Fortunately, the USPSTF recently proposed a guideline update that, if approved, would lower the recommended age to 40 for average-risk women.

This would bring all medical associations and societies in closer alignment. If approved, it would be the biggest breast imaging news in over a decade. A win for clarity and a win for women.

Why are the USPSTF’s recommendations so important? As the independent panel of primary care and prevention experts, the task force develops recommendations for primary care providers. The USPSTF influences how doctors act and what the recommendations they make to their patients.

After the 2009 recommendation, many primary care providers also stopped conducting clinical breast exams for women, meaning that women between the ages of 40 to 49 were neither physically examined nor routinely imaged for breast cancer until they were 50, unless they were at elevated risk for developing the disease or felt a lump and rushed to the doctor to get checked out.

Around 75 percent of breast cancers are diagnosed in patients who are not high-risk. This tells us that screening all women is important, and the earlier a woman’s cancer is diagnosed the better the outcome.

That is why I applaud this draft recommendation and urge people to support the draft language during the USPSTF’s comment period, which ends on June 6. You can review the recommendation and leave your comment here.

While the shift does not create a completely aligned message, it is an important step. Next, I hope the medical community can come to a consensus on how often screening mammograms should be performed in average-risk women.

The USPSTF maintains in its new guideline recommendations that average-risk women should have a mammogram every two years, while the ASBrS, ACOG, ACR, and NCCN recommend annual screening. Make no mistake: Biennial screening does save lives. But extending annual screening to every other year principally increases the risk that the most aggressive, fastest-growing cancers are diagnosed too late.

In the meantime, if you have been touched by breast cancer, please consider voicing your support for this needed guidelines update.

This doesn’t completely end the confusion, but it’s an important step in the right direction. More than 60,000 women in the U.S. are diagnosed annually with breast cancer between the ages of 40-49. Earlier screening means more lives saved. Make your voice heard here.

January Lopez is a director of breast imaging, Hoag Memorial Hospital Presbyterian, Newport Beach, CA.