Earlier this year, the US Preventive Services Task Force (USPSTF), an independent, national volunteer group of experts in disease prevention and evidence-based medicine, updated its guidelines for breast cancer screenings, recommending mammograms every other year, starting at age 40 and continuing through age 74. That is a shift from the prior recommendation to start between the ages of 40 and 50 as determined by your doctor. But the USPSTF recommendations left a lot of questions unanswered, saying that more research needs to be done before it can issue guidelines that are beneficial for all women. Bottom Line Personal asked Lucy B. Spalluto, MD, breast imaging specialist at Vanderbilt University, to fill in these gaps…
The USPSTF bases its recommendations on evidence supporting the effectiveness of preventive care services aiming to improve the health of individuals across the country. Several professional medical organizations also put forth breast cancer screening guidelines. The American College of Radiology (ACR), the Society of Breast Imaging (SBI) and the National Comprehensive Cancer Network (NCCN) recommend annual screening mammography starting at age 40 for women at average risk for breast cancer.
The USPSTF guidelines for biennial screening beginning at age 40 are for women at average risk for breast cancer. Perhaps the most glaring gap in the USPSTF guidelines is that they don’t address women who are at higher-than-average risk for breast cancer, many of whom may not even know they are at high risk. Women at high risk for breast cancer may need to start mammography screening at younger ages or have additional types of supplemental breast cancer screening beyond mammography (ultrasound or MRI). For many women, defaulting to the USPSTF average-risk guidelines could mean missing opportunities for earlier identification of cancers. Here’s how you can protect yourself…
Find out your degree of risk
Every woman should know her own risk level and whether that means she should start mammography screening at an earlier age, more often and/or with more than just a mammogram. Example: Women who know that they are higher risk at a young age might begin breast cancer screening as early as age 25 or 30. That can help identify cancers at earlier stages when they’re more treatable.
Family history is one of the biggest risk factors. Women who have a first-degree blood relative (for example, your mother or a sister) diagnosed with cancer…multiple family members diagnosed with cancer…male relatives diagnosed with breast cancer…or family members diagnosed with breast cancer when they are under the age of 45 should consider learning more about their own risk for breast cancer.
The easiest way to determine your lifetime risk for breast cancer is to talk with a health-care provider who can help you learn about your personal risk using a risk assessment tool, such as the Tyrer Cuzick, BRCAPRO and CanRisk models. These risk-assessment tools incorporate several factors such as family and personal history of breast cancer, hormonal factors and sometimes breast density. If the indication is that you’re at a higher-than-average risk, your provider can help you develop a personalized screening regimen.
It is important to complete the assessment with a health professional, such as a nurse experienced in breast cancer, a genetic counselor or your physician. Once you get your result, you may not know exactly what to do with it. Some women might assume that “average risk” means they don’t need to screen at all, which isn’t the case.
Guidance for Specific Situations
Other health organizations, such as the ACR and the SBI, do offer guidelines for key groups of women not addressed by the USPSTF…
Dense breasts. Dense breast tissue poses a dual threat. Dense breast tissue is an independent risk factor for developing breast cancer…and it makes it harder to see cancer on a mammogram because the dense tissue can mask it.
Federal legislation being enacted in September 2024 will require health-care providers to inform women if the breast tissue is “dense” or “not dense” at the time of their screening mammogram. Women with dense breast tissue will be notified that dense tissue can increase their risk for breast cancer, make it harder to find and that other imaging tests may be needed to find breast cancer. Examples: Women with dense breasts might request a 3D mammogram, an imaging technique that improves detection for women in general and those with dense breasts in particular. They might also benefit from having a supplemental imaging study, such as ultrasound or MRI.
You’re 75 or older. USPSTF guidelines conclude that there is not sufficient evidence to assess the benefit of screening mammography in women 75 and older. Guidelines from the ACR and the SBI encourage women 75 and older to continue screenings as long as they are able to act on the results, meaning they don’t already have health conditions that might limit their life expectancy or have other extenuating circumstances that would keep them from seeking breast cancer treatment if cancer was found.
You’re a woman of color. Black women are often diagnosed with more aggressive breast cancers and at younger ages than white women. Black women are also 40% more likely to die of breast cancer than white women. Asian and Pacific Islander women in the US are experiencing breast cancer in greater numbers than in the past, yet nearly 40% of these women fail to get regular screenings. Ongoing research is needed to develop screening guidelines recommendations that benefit all women. Going just one additional year between screenings, as the USPSTF outlines, could negatively impact the outcomes for women more likely to be diagnosed with cancer at younger ages.
Research is also being done to improve risk assessment calculators so they are effective across diverse populations. This includes finding strategies to make both patients and providers more aware of these calculators so they are used more regularly in medical settings, allowing for more personalized screening regimens based on individual risk. Research is also underway to evaluate different screening regimens to see which ones are best for different risk levels—which types of imaging studies at what intervals and starting at what ages.
