USPSTF Lowers Recommended Screening Age for Breast Cancer to 40 Years Old

The US Preventive Services Task Force (USPSTF) has released updated recommendations for the screening for breast cancer in women, with the organization now lowering their recommended age for biennial screenings from 50 to 40 years based on new data.

The latest update, which is the first on the topic since 2016, offers a B-graded recommendation for biennial screening mammography in women aged 40 to 74 years but concluded there was insufficient evidence to determine the balance of benefits and harms of screening mammography in women 75 years or older as well as the balance of benefits and harms of supplemental screening for breast cancer with breast ultrasound or magnetic resonance imaging (MRI), regardless of breast density.¹

“I think that the main message is that screening should start for the average risk woman at the age of 40. And should be every other year. That's important to know that if we make that change from 50 to 40, we have the potential for reducing mortality from breast cancer by about 20%,” explained Carol Mangione, MD, member of the USPSTF and the chief of the Division of General Internal Medicine and Health Services Research at UCLA Health, in an interview with Contemporary OB/GYN—a sister publication of HCPLive.²

The recommendations made by the UPSTF are based on the results of an evidence report and systematic review conducted by a team of 5 on behalf of the task force. This group assessed studies comparing different breast cancer screening strategies published in the MEDLINE or Cochrane Library databases through August 22, 2022, with literature surveillance occurring through March 2024. In total, 7 randomized clinical trials and 13 nonrandomized studies were included.^1,3

In 2016, the group had awarded a B graded recommendation for women aged 50 to 74 years to undergo biennial screening mammography and a C-graded recommendation to start screening mammography in women in women aged 40 to 49 years, suggesting the decision to start screening before the age of 50 years should be an individual one.⁴

• The USPSTF made the following statements as it relates to magnitude of net benefit for each of their latest recommendations:
• The USPSTF concludes with moderate certainty that biennial screening mammography in women aged 40 to 74 years has a moderate net benefit.
• The USPSTF concludes that the evidence is insufficient to determine the balance of benefits and harms of screening mammography in women 75 years or older.
• The USPSTF concludes 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.

In addition to the updated recommendations, the new recommendation statement also has a specific focus on calling attention to pronounced inequities in breast cancer stage at diagnosis, subtype, and mortality, particularly among non-Hispanic Black women.¹

“The other really important thing to note is that Black women in the US, if they get breast cancer, they're 40% more likely to die from it,” added Mangione, who also serves as the Department of Medicine Executive Vice Chair for Health Equity and Health Services Research at UCLA.² “For some reason, breast cancer happens at younger ages in a more aggressive form in Black women and what we found from our modeling studies that going from age 50 to 40, that black women benefit the most from that change. So clinicians should certainly encourage their Black female patients to start at 40.”

In an editorial, Joann G. Elmore, MD, MPH, of the David Geffen School of Medicine at UCLA, and Christoph I. Lee, MD, MS, of the Fred Hutchinson Cancer Center and the University of Washington School of Medicine, commended the task force for their efforts and diligence in creating these new recommendations. However, the duo also called attention to pitfalls such as the shortcomings of available research on the topic as well as the lack of information around the emerging use of artificial intelligence support tools.⁵

“The updated USPSTF recommendations highlight a rapidly evolving intersection of technology and equity within an already complex health care ecosystem in which disparities remain a persistent problem. It is important that physicians continue to practice the art of medicine to ensure that women make informed decisions aligned with their preferences,” wrote the pair.⁵ “Moving ahead, population-level data collection throughout the entire breast care continuum is imperative to pinpoint interventions at individual, neighborhood, and health care facility levels that can help address existing disparities gaps across the entire screening and diagnostic episode of care.”

References:

1. US Preventive Services Task Force. Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. Published online April 30, 2024. doi:10.1001/jama.2024.5534
2. Krewson C. USPSTF releases new recommendations for Breast Cancer Screenings. Contemporary OB/GYN. April 30, 2024. Accessed April 30, 2024. https://www.contemporaryobgyn.net/view/uspstf-releases-new-recommendations-for-breast-cancer-screenings.
3. Henderson JT, Webber EM, Weyrich MS, Miller M, Melnikow J. Screening for Breast Cancer: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. Published online April 30, 2024. doi:10.1001/jama.2023.25844
4. US Preventive Services Taskforce. Breast cancer: Screening. Archived: Breast Cancer: Screening | United States Preventive Services Taskforce. January 11, 2016. Accessed April 30, 2024. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening-january-2016.
5. Elmore JG, Lee CI. Toward More Equitable Breast Cancer Outcomes. JAMA. Published online April 30, 2024. doi:10.1001/jama.2024.6052