The U.S. Preventive Services Task Force (USPSTF) has come up with new guidelines for checking for breast cancer. For the first time in 14 years, a link opens in a new tab or window.
The 2009 and 2016 guidelines recommend screening mammograms every two years for women 50 to 74. They also say that women younger than 50 should decide for themselves if they want to start screening. Some important changes have been made to the newly proposed guidelines for younger women, but there is still room for improvement, especially for older women, women with dense breasts, and Black women.
Starting at age 40, the new draught guidelines suggest that all women get screened for breast cancer every other year. That is a very big change. In the U.S., one out of every eight women gets breast cancer, and it happens once every ten years. About 9% opens in a new tab or window of all breast cancers that occur in women younger than 45. Women in their 40s could be saved by lowering the screening age from 50 to 40.
Unfortunately, the proposed guidelines still say that screenings should be done every 2 years instead of every year. Research has shown that getting a mammogram once a year starting at age 40 saves more lives than not getting screened, cutting breast cancer deaths by up to 40%opens in a new tab or window. The detection of cancers, when they are smaller and easier to treat, is aided by having a mammogram every year as opposed to every other year. This could indicate that you don't require invasive therapies like chemotherapy and mastectomy.
Another problem with the new draught guidelines is that they don't give older women clear advice based on evidence. As with the current guidelines, the Task Force says that women should only get screened for breast cancer until they are 74 years old. They also say that there isn't enough information to weigh the benefits and risks of screening for women 75 and older.
But breast cancer is still a risk for women 75 and older open in a new tab or window, even though many women today live well into their 80s and 90s. Until there is enough research to support a screening recommendation, older women must decide with their clinicians what is best for their individual health needs based on their preferences, values, and health history. We need to do more research on this age group.
In their new draught statement, the USPSTF says that having dense breasts is essential. About half of all women in the U.S. have dense breast tissue. It's essential to know how dense your breasts are because women with dense breasts are more likely to get breast cancer. Plus, mammograms are harder to read when the breasts are dense, which means that some breast cancers may not be found.
Even though the Task Force was aware of the risks that come with dense breasts, they did not recommend extra screening. Instead, they said that more research is needed before they can make a recommendation. But studies have already shown that both breast ultrasound and MRI can help women with dense breast tissue find cancer earlier. In March, the FDA changed its rules so that all women who get a mammogram must be told about their breast density opens in a new tab or window. Within 18 months, providers of mammograms must follow the new rules. Women with dense breasts and their doctors need help figuring out what other tests they should get. They won't be able to find this kind of advice in the suggestions made by the USPSTF.
Lastly, the USPSTF said that Black women are more likely to get breast cancer and asked for more research to be done on health differences in breast cancer. This is important because Black women are 40% more likely to die from breast cancer and more likely to get aggressive breast cancers at young ages. In their new draught statement, the USPSTF says that lowering the screening age to 40 will help reduce some of the difference and calls for more research.
The Task Force could have taken steps right now to help even out some of the differences. Many Black women don't know that they are at a greater risk. All women should get a risk assessment and education before they turn 30. This is especially important for Black women and women of other ethnic groups who are more likely to get HIV. Using a universal risk assessment, high-risk women could be found and could work with their doctors to customize their screening. Some of these women may need to start screening as early as 25–30 years old, and they may benefit from tests other than mammograms, such as MRIs.
Overall, the proposed guidelines are a step in the right direction, and the Task Force seems to be looking at breast cancer screening more greatly. But these suggestions could be improved, especially for older women, women with dense breasts, and Black women.
The USPSTF wants more research to be done. Unluckily, these women need help right now. It could make or break their lives.
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