MMost women should start screening mammograms for breast cancer at age 40 and have screenings every two years until they reach age 75, according to new recommendations from a panel of experts.
The U.S. Preventive Services Task Force (USPSTF), which is an independent, government-funded group of experts, regularly analyzes data and makes recommendations on health issues, and many health care providers follow them. Decided to review its advice on mammography screening, last issued in 2016. That guideline said that women should begin regular mammography screenings every two years starting at age 50, and that women ages 40 to 49 should discuss with their doctors the best screening regimen for them.
Here’s what you should know about the latest changes.
When should most women have their first mammogram?
The new recommendation is based on additional evidence that has emerged since 2016, says Dr. John Wong, vice president of the USPSTF. According to data from the National Cancer Institute, breast cancer rates in women in their 40s began to increase by 2% annually in 2015, and this trend justified a change in recommendations to start screening a decade earlier. “Our current data shows that this recommendation could potentially save one in five women who would otherwise die if they waited until age 50 to get screened,” says Wong. “This will potentially save 25,000 women from dying from breast cancer. We think it’s a big win.”
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Maxine Jochelson, a radiologist at Memorial Sloan Kettering Cancer Center, says the review is long overdue. “Data has shown for years that by not screening women in their 40s and 50s, if women in that age group develop breast cancer, they are more likely to need chemotherapy, more likely to need major surgery and more often they contract more aggressive cancers. “, she says. “I think they’re late to the party.”
It’s unclear what is contributing to the increased risk among women in their 40s. But Wong says the working group looked at whether the USPSTF’s recommendation at that time — starting mammograms when women turn 50 instead of 40, as the group’s previous guidance advised — was a factor, as some advocates had warned. “Screening rates have remained consistent throughout this period,” he says. “So that’s not the cause.” The most recent data includes different populations of women, however, it incorporates different types of screening and treatment options that were not available when previous populations were studied, so more screening may be leading to more diagnoses, for example.
The current recommendation now aligns USPSTF guidance with that of other health groups, including the American Cancer Society. This group advises women to start screening at age 45, annually until age 54, and every two years thereafter.
Why did the recommendation change?
Wong says the new guidelines reflect the changing benefits and risks of screening and its consequences, which include additional testing as well as the risk of false positives. The increased risk of breast cancer among women in their 40s has tipped the balance in favor of starting screening earlier.
What about women with dense breasts?
About half of women in the US have dense breast tissue; for them, mammograms are less reliable in detecting cancer. The working group is less clear about whether these women should follow the same recommendations. It says the evidence supporting the benefits of additional screening — with MRIs or ultrasounds, which doctors often recommend if mammograms are negative or inconclusive — is not “sufficient.” Wong says more research is needed to understand whether these additional imaging tests help women get diagnosed earlier and, ultimately, allow them to live longer. “We simply don’t have clear evidence at this point,” he says.
Will insurance cover mammograms after age 40?
All insurance companies (with few exceptions) must cover the cost of mammograms without a copay for women who have them as part of regular screenings starting at age 40. Protection of Access to Lifesaving Exams Act which was passed by Congress in 2019. Because of this law, the new guidelines should not affect insurance coverage for mammograms for women in their 40s.
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But because the task force says the evidence for additional screening is “insufficient,” women with dense breast tissue may still have to pay out-of-pocket for additional screening beyond a mammogram. This could lead to less follow-up of these women and, ultimately, could delay any diagnosis of breast cancer until later stages, when the disease is more difficult to treat. “We worry about what this means for access and utilization for these women to say there is inconclusive evidence to support supplemental imaging,” says Molly Guthrie, vice president of policy and advocacy at the Susan G. Komen Breast Cancer Foundation.
Guthrie notes that many states already require mammography centers to notify women if they have dense breast tissue, so that they and their doctors are aware that mammogram readings may have missed possible warning signs of cancer. This requirement will apply to all mammography centers starting in September, after the U.S. Food and Drug Administration, which regulates the facilities, issued a new rule last year demanding the information. “The FDA is trying to get to the point of promoting the conversation about dense breast tissue so that women can have a dialogue with their providers,” says Guthrie. “But if you don’t do anything to change coverage, you won’t increase utilization.”
Wong defends the completion of the task force, seeing it as an invitation for further study. “We would love to have enough evidence to help women with dense breast tissue live longer, healthier lives, and we urgently call for more research to get this evidence,” he says. —and the benefits and harms—to make recommendations that help people in this nation stay healthy and live longer.”
Correction, April 30
The original version of this story mischaracterized the rise in cancer deaths among women in their 40s. The incidence of cancer, not the mortality rate, has increased by 2% per year.
This story originally appeared on Time.com read the full story
