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U.S. Preventive Services Task Force Clarifies Mammography Recommendations for Women in Their 40s

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Key Points

  • The updated USPSTF guidelines on mammography screening still recommends that women aged 50 to 74 get mammography screening for breast cancer every 2 years.
  • The net benefit of mammography screening in the general population of women aged 40 to 49 is small, and the updated guidelines emphasize that the decision to start screening mammography in these women should be an individual one.
  • There is insufficient evidence to recommend the use of tomosynthesis as a screening tool for breast cancer or of adjunctive screening for breast cancer in women with dense breasts on an otherwise negative screening mammogram.

The U.S. Preventive Services Task Force (USPSTF) has issued its updated draft recommendation statement on mammography screening guidelines. The revised guidelines still recommend that women aged 50 to 74 get mammography screening for breast cancer every 2 years and now states that the decision to start screening mammography in women in their 40s should be an individual one made after discussion with their physicians about the risks and benefits of the tests.

The recommendation for women aged 40 to 49 remains grade C. Grade C recommendations call for selectively offering or providing mammography services to individual patients based on professional judgment and patient preferences but state that “there is at least a moderate certainty that the net benefit is small.”

Clarifying the Message

While the age recommendations for screening mammography in the updated guidelines are essentially the same as the ones issued in 2009, the updated guidelines emphasize that the decision to start screening mammography in women younger than 50 should be an individual one. “Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years,” wrote the task force members. However, while screening mammography in women aged 40 to 49 may reduce the risk of dying of breast cancer, it also puts them at increased risk for overdiagnosis of a noninvasive or invasive breast cancer that would not have developed into a threat to their health. The number of deaths averted through mammography screening is much smaller than in older women, “and the number of false-positive tests and unnecessary biopsies are larger,” they wrote.

The USPSTF’s recommendations remain at odds with guidelines released by the American Cancer Society and the American College of Obstetricians and Gynecologists, which suggest annual mammography screening beginning at age 40.

Update of Previous USPSTF Recommendations

For the new guidelines, the USPSTF said that the current evidence is insufficient to assess the benefits and harms of the use of tomosynthesis (three-dimensional mammography) as a screening tool for breast cancer. The task force also concluded that there is insufficient evidence to assess the balance of benefits and harms of adjunctive screening for breast cancer in women with dense breasts using screening tools such as breast ultrasound, magnetic resonance imaging, or tomosynthesis.

The public has until May 18, 2015, to comment on the USPSTF’s draft guidelines.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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