Women should get a mammogram every two years starting at age 40, according to new guidelines released Tuesday by the U.S. Preventive Services Task Force.
This is a significant reduction in age from previous recommendations, which stipulated that women should begin screening at age 50 and suggested that women in their 40s should talk to their doctor about whether to do so.
The change, first published in draft form last year, is a response to rising cancer rates among women in their 40s, as well as evidence that early mammograms help save lives. The breast cancer rate among women ages 40 to 49 increased 2% per year, on average, from 2015 to 2019, according to the National Cancer Institute.
“With this increasing incidence of breast cancer in women in their 40s, it points to mammography being even more beneficial,” said Dr. Wanda Nicholson, chair of the task force.
The group, made up of independent experts, estimates that its new recommendations, published in the journal JAMA, could save up to 20% more lives than the old ones.
Insurance companies typically follow the task force's recommendations when determining coverage and reimbursement, although many plans already cover mammograms for women age 40 and older.
Primary care physicians or obstetrician-gynecologists order mammograms (X-ray images of the breast) for their patients, and the service is usually provided by a technician in a diagnostic imaging center or radiology department. Patients place each breast between two plates and a machine takes x-ray images of the breast tissue.
If abnormal lesions are detected on scans, patients may need additional mammograms, an ultrasound, or sometimes a biopsy or MRI to find out if cancer is present.
The task force's new guidelines do not apply to women with a personal history of breast cancer, those who have had an abnormality in a previous biopsy, or those who have a genetic marker for the disease.
The recommendations only apply to women up to 74 years of age.
Some major medical groups say the task force's new guidelines are not enough. The American Cancer Society (ACS) recommends annual screenings (rather than every two years) for women ages 45 to 54, with the option of moving to biennial screenings after age 55. It does not recommend stopping screening. revisions at an age, as long as they are expected to live at least a decade longer.
“We are disappointed that the updated recommendations do not include women over the age of 74,” the ACS said in a statement. “Millions of women over the age of 75 are in very good health and are expected to live many more years during which their risk of breast cancer will remain high,” she added.
But Nicholson said there was not enough evidence to recommend mammograms for women aged 75 and older.
“We want to assure people that we have not forgotten women aged 75 and older,” she said, “we urgently call for more research for this population.”
The American College of Radiology (ACR), for its part, expressed disappointment that the task force did not suggest annual screenings starting at age 40, as the college recommends.
The ACR also suggests that all women – especially black and Jewish women – talk to their doctors about their risk of breast cancer before they turn 25. Black women are 40% more likely to die from breast cancer than white women, and Jews of Eastern European descent have an above-average risk.
However, the task force's analysis concluded that undergoing scans each year can yield more false-positive results, which can lead to unnecessary biopsies or women being treated for injuries that do not necessarily pose a health risk.
“The biennial review, compared to the annual review, has a much more favorable balance of benefits and harms,” Nicholson said.
Hoebe Freer, chief of breast imaging at the University of Utah Huntsman Cancer Institute, says many women still prefer to have an annual scan.
“Usually the risk is that they will call us back for more tests, perhaps an ultrasound, and then they will tell us that the woman is fine and can go back to routine tests. “Most are willing to tolerate that risk in exchange for an additional reduction in mortality,” she says.
The ACR also recommends an additional MRI each year for women with dense breasts, which are associated with an increased risk of breast cancer. But the task force said it needed more research before suggesting that for women with denser breast tissue.
“Could additional imaging help them live healthier and longer? The bottom line is that, with our current review, the evidence is not there,” Nicholson added.
