Breast cancer survival rates have come a long way in the last several decades. According to the
Early diagnosis through screening has been a key driver in that statistic.
This week, the US Preventative Task Force (USPTF) released a draft recommendation statement on breast cancer screening — a first since 2009. The recommendation is to begin mammography screenings a decade earlier than previously, from the age of 50 to the age of 40, in women with average risk factors.
The move by USPTF is certainly a step in the right direction to ensure more women have access to life-altering breast screenings. Unfortunately, breast cancer screening recommendations are not often aligned across various medical organizations.
The American Cancer Society
The American College of Obstetricians and Gynecologists (ACOG) recommends a screening mammogram starting at the age of 40 every 1 to 2 years.
When these recommendations leave room for interpretation, it puts lives at risk. Without consensus across the various medical organizations, it can create inconsistency in benefit coverage and access to testing.
The USPTF recommendations are often considered the gold standard for physicians. This new update creates a consensus across the various medical organizations which in turn can improve overall coverage insurance and access to these screening tests.
The new recommendations from USPTF urged more studies to understand the benefit and harm ratio of mammography for women ages 75 years and older. ACOG’s recommendations as well as most practicing clinicians would note – age alone should not be the deciding factor on whether to continue or discontinue screenings. The benefits and harm of screening at any age should be a discussion with your provider. Lifestyle and life expectancy should be the discussion with the provider rather than basing it purely on age.
The new USPTF recommendations also did not outright recommend other imaging such as MRI and/or ultrasound for dense breast tissue, urging more research to understand the benefit and harm of these supplemental imaging options.
It is known that dense breast tissue can increase the risk of breast cancer. Dense breasts can also make it difficult to read mammograms, increasing the chances of misinterpretations. Most patients may not be aware of the increased risks associated with having dense breast tissue.
Many women who have dense breast tissue know that they have to follow a mammogram with an additional MRI and/or ultrasound. However, the USPTF recommendations did not outright recommend a clear path for supplemental imaging, stating more research is needed.
What remains to be seen is the impact of these guidelines in improving the health disparity challenges faced by Black, Asian, Hispanic/Latina, Native American, and Alaskan Native Women.
The release urges the need for more research in having more precise risk evaluation and follow-up for these specific populations.
We know that the morbidity and mortality rates for breast cancer are higher in these groups, particularly in Blacks.
Ethnic variations, access to screening and information, cultural beliefs, and other social determinants of health are all barriers to reducing the disparity in breast cancer survival rates amongst the various groups.
As I said earlier, the updated USPTF recommendations bring us closer to addressing the changes needed to improve access to screening services, education, and continued dialogue.
But we need more.
— Jenny Yu, MD FACS is the chief health officer at RVO Health which owns Healthline Media.