Health experts on Tuesday issued a sweeping revision to the standard medical advice on mammograms, amid an increase in breast cancer diagnoses among young women and continued high death rates, particularly among black women.
Women of all racial and ethnic backgrounds who are at average risk for breast cancer should start getting regular mammograms at age 40, rather than considering it as an individual decision until age 50, the US Preventive Services Task Force said.
The group publishes influential guidelines on preventive health, and its recommendations are generally widely accepted in the United States. But the new advice, released as a draft, suggests the opposite.
In 2009, the task force raised the age for starting routine mammograms from 40 to 50. At the time, researchers were concerned that earlier screening could do more harm than good, leading to unnecessary treatment for young women. will be negative.
But there have been worrying trends in breast cancer in recent years. These 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 from breast cancer at twice the rate of white women of the same age.
“We don’t know why there is an increase in breast cancer among women under 40,” Dr. Carol Mangione, the immediate past chair of the task force, said in an interview. “But when more people in a certain age group get a condition, screening for that group can be more impactful.”
The new recommendation covers more than 20 million women between the ages of 40 and 49 in the United States. In 2019, About 60 percent of this age group are women 76 percent of women ages 50 to 64 and 78 percent of women ages 65 to 74 said they had a mammogram in the past two years.
The panel said there was insufficient evidence to make recommendations one way or the other for women aged 75 and older.
Dr. Mangione said the task force presented for the first time studies of breast cancer specifically among black women, as well as all women, and that more research is needed on factors that drive racial disparities. The task force called for a clinical trial to compare the effectiveness of annual and biennial screening among black women.
Overall, mortality from breast cancer has decreased in recent years. However, it is the second most common cancer in women after skin cancer and the second leading cause of cancer deaths among women in the United States after lung cancer.
Between 2000 and 2015, breast cancer diagnoses among women under 40 increased by less than 1 percent. But between 2015 and 2019 it increased by an average of 2 percent per year, the task force noted.
The reasons are not entirely clear. Delaying childbearing, or not having children, may be driving the rise, said Rebecca Siegel, senior scientific director of surveillance research at the American Cancer Society. Having children before age 35 reduces the risk of breast cancer, as does breastfeeding.
However, he noted that there is year-to-year variation in diagnosis rates. Other researchers suggest the increase among young women may simply reflect more screening, said Dr. Steven Woloshin, a professor of medicine at Dartmouth University.
Frequent screening can be harmful, leading to unnecessary biopsies, anxiety and treatment for slow-growing cancers that might not have been life-threatening, researchers have found.
Yet in 2009, criticism from patients and advocacy groups surfaced after the task force recommended that women begin getting regular mammograms after age 50. Critics of the guidelines fear it will reduce fertility among young women. A desire to reduce medical costs motivated this recommendation.
At the time, the group called for longer intervals between mammograms: once every two years rather than annual scans. That recommendation still stands.
The American Cancer Society differs on this key point. The society says women between the ages of 40 and 44 can opt for screening, but Starting at age 45, women should have a mammogram every year Until age 55, when the risk of breast cancer begins to decrease.
Cairn E. Knudsen, the Cancer Society’s chief executive, said he welcomed the task force’s recommendation to start routine screening at a younger age because it would alleviate confusion resulting from conflicting recommendations from medical groups.
But, “We are committed to annual screening. Cancers in postmenopausal women grow rapidly, and it is important that they do not develop and go undiagnosed within two years.
The task force’s new recommendation applies to all populations assigned at birth to women who are asymptomatic and at average risk for breast cancer, including those with dense breast tissue and a family history of breast cancer.
But the advice doesn’t apply to people who already have breast cancer, have genetic mutations that increase her risk, had breast lesions identified in previous biopsies, or had high doses of radiation to the breast that raise the risk of cancer.
These women should consult their doctors about how often they should be screened.
The task force stressed that it is important for black women to start getting mammograms at age 40 because they are more likely to get aggressive tumors at a younger 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 universal, one-size-fits-all approach to screening. In favor of a “risk-adapted” approachThis would mean screening black women six to eight years earlier than white women.
“Recommendations should be tailored by race and ethnicity to maximize the benefits of screening, minimize its harms, and reduce the current racial disparity,” said Dr. Mahdi Falla, who studies risk-adapted cancer prevention at the German Cancer Research Center in Heidelberg. .
But screening alone does not improve survival rates for black women, who not only develop aggressive tumors, but also struggle with delays in seeking medical care and life circumstances that make treatment difficult.
The task force’s new report notes, for example, that this is especially true for black women, when follow-up for abnormal breast scans is often delayed.
“Oftentimes when it’s a black woman, you hear a story that you wish you hadn’t heard,” Dr. Mangione said.
“Often, these women find a lump on their own, or they know the discharge is abnormal, and they go in and they’re fired. They are ultimately diagnosed because they are not ready to take no for an answer.