Alarmed by the increase in breast cancer diagnoses among younger women and the continuing high death rates among Black women in particular, health experts on Tuesday offered a stark revision of the standard medical advice for mammograms.
The U.S. Preventive Services Task Force said women of all racial and ethnic backgrounds at risk of breast cancer should begin getting regular mammograms at age 40 instead of waiting until they are 50, as previously recommended.
The group issues influential guidance on preventive health, and its recommendations are usually widely adopted in the United States. But the new advice, released as a draft, is something of a reversal.
In 2009, the USPSTF raised the starting age for routine mammography to 50, from 40. At the time, researchers were concerned that early screening might do more harm than good, leading to unnecessary treatment for younger women, including biopsies that Turned out to be negative.
But there have been worrying trends in breast cancer in recent years. They include an apparent increase in the number of cancers diagnosed in women under 50 and a failure to narrow the survival gap for younger black women, who die of breast cancer at twice the rate of white women of the same age.
“We don’t really know why there is an increase in breast cancer among women in their 40s,” Dr. Carol Mangioni, former chair of the task force, said in an interview. “But when more people in a particular age group develop a condition, screening that group is going to be more impactful.”
The new recommendation covers more than 20 million women in the United States between the ages of 40 and 49. in 2019, About 60 percent of women are in this age group They said they had had mammograms in the past two years, compared with 76 percent of women ages 50 to 64 and 78 percent of women ages 65 to 74.
The panel said there was not enough evidence to make recommendations one way or the other for women 75 or older.
d said. Mangioni said the USPSTF has commissioned studies of breast cancer especially among Black women, as well as for all women, for the first time, and needs more research into the factors that lead to the racial disparity. The task force is also calling for a clinical trial to compare the effectiveness of annual and biennial screening among black women.
In general, the death rate from breast cancer has decreased in recent years. However, it is still the second most common cancer in women after skin cancer and is the second leading cause of cancer death after lung cancer among women in the United States.
Breast cancer diagnoses among women in their 40s increased by less than 1 percent between 2000 and 2015. But the rate rose an average of 2 percent annually between 2015 and 2019, the task force noted.
The reasons are not entirely clear. Postponing childbearing, or not having children at all, could lead to an increase in height, said Rebecca Siegel, senior scientific director for surveillance research at the American Cancer Society. Having children before the age of 35 reduces the risk of breast cancer, as does breastfeeding.
However, she noted that there was significant year-to-year variation in diagnosis rates. Other researchers suggest that the increase among younger women may simply reflect more screening, said Dr. Stephen Woloshin, professor of medicine at Dartmouth University.
Researchers have found that repeated screening can cause harm in itself, leading to unnecessary biopsies that cause anxiety and treat slow-growing cancers that would never have been life-threatening.
However, there was a firestorm of criticism in 2009, by both patients and advocacy groups, when the task force advised that only women over the age of 50 have regular mammograms. Critics of this guidance feared malignancies among young women would be missed and suggested that a desire to reduce healthcare costs drove the recommendation.
At the time, the committee also advocated for longer intervals between mammograms: once every two years, rather than annual screenings. This recommendation still stands.
The American Cancer Society disagrees on this key point. The association says women ages 40 to 44 should be able to choose to be screened Starting at age 45, women must have a mammogram every year Until the age of 55, when the risk of developing breast cancer begins to decrease.
Karen E. Knudsen, CEO of ACS, said she welcomes the staff’s advice to start routine screening at a younger age because it will alleviate confusion caused by contradictory recommendations from medical groups.
However, she said, “We are steadfast in annual screening. Cancers in perimenopausal women grow faster, and it is important that they do not develop during the two-year period and go undetected.”
The task force’s new recommendation applies to all people designated female at birth who are asymptomatic and have an average risk of developing breast cancer, including those with dense breast tissue and a family history of breast cancer.
But the advice does not apply to anyone who already has breast cancer, carries genetic mutations that increase their risk, has had breast lesions identified in previous biopsies or has been exposed to high doses of radiation to the chest, which increase the risk of cancer.
These women should consult their doctors about how often they should be examined.
The task force stressed that it is important for black women to begin mammograms at age 40, as they are more likely to develop aggressive tumors at an early age and are 40 percent more likely to die from breast cancer than white women.
Some scientists have called for a move away from a one-size-fits-all blanket approach to screening In favor of a “risk-adjustable” approachwhich means black women are screened six to eight years earlier than white women.
“The recommendation should be tailored by race and ethnicity to maximize the benefits of screening and minimize its harms and address the existing racial disparity,” said Dr. Mahdi Falah, who studies risk-adaptive cancer prevention at the German Cancer Research Center in Heidelberg. .
But screening alone will not improve survival rates for black women, who are not only more likely to develop aggressive tumors but also struggle with delays in obtaining medical care and with life conditions that make treatment difficult.
The task force’s new report found, for example, that while follow-up to abnormal breast exams is often delayed, this is particularly true of black women.
“A lot of times when you’re a black woman, you hear a narrative that you wish you hadn’t heard,” said Dr. Mangioni.
“A lot of times, these are the women who find a lump, or a discharge that they know is abnormal, and it comes in and they’re thrown out. And it’s only because they’re not willing to accept no for an answer that they end up being diagnosed.”