The expert group that sparked controversy over mammography now says testing should start at age 40
The science behind breast cancer prevention is undergoing a significant shift that promises to impact when and how frequently American women receive mammograms. An influential group plans to recommend that US women begin breast cancer screening mammograms at age 40 and continue to undergo them every two years until age 75. This is expected to significantly reduce breast cancer-related fatalities compared with the previously approved mammography regimen.
The new list of draft recommendations from the U.S. Preventive Services Task Force marks a significant change from the controversial advice released in 2009, which was reiterated in 2016, that most women could safely wait until age 50 to undergo a breast scan for signs of potential malignancies. The panel also stated that women at medium risk could be screened every two years instead of annually.
The reason cited for fewer mammograms in a woman’s lifetime was the frequency at which breast cancers are overdiagnosed, leading to unnecessary treatments and invasive procedures. It was also acknowledged that mammograms expose women to radiation, which in some cases could lead to cancer.
The changes in the draft recommendations are driven by various factors, including a growing awareness of the risks faced by women with dense breasts that make malignancies harder to detect. Nearly half of all women have dense breasts, and the task force has little research on whether to recommend additional screenings or other types of imaging, such as MRIs or ultrasounds.
The new recommendations from the task force are expected to help save lives and prevent more women from dying due to breast cancer. However, they have been met with criticism from some quarters. Dr. Debra L. Monticciolo, a radiologist at Massachusetts General Hospital, criticized the decision to recommend mammograms every two years, stating that it will only exacerbate racial disparities since black and Jewish women tend to die of breast cancer before they turn 50 more often than white women as a whole.
The task force itself has noted other consequences of the more intense screening program, including the tripling of the number of mammograms a typical woman receives, as well as an increase in the overdiagnosis rate from 8% to 17%.
Although it may seem counterintuitive that screening less often could save more lives, some experts point out that this is a possibility that requires rigorous testing. There is limited research on screening women over 75 years of age, and the task force assigned much lower confidence levels to the bi-yearly mammography schedule.
The draft recommendation is open to public comment until June 5 on the task force website.
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