USPSTF issues updated recommendation on breast cancer screening that supports screening starting in women at age 40

The USPSTF's newly published final recommendations support breast cancer screening starting in women at age 40, but they don’t go as far as many screening advocates had hoped.

In addition to the recommendation for biennial breast cancer screening for women ages 40 to 74, the take force stuck with its draft recommendations from 2023, reporting that it found insufficient evidence for screening women 75 and older. The USPSTF concluded that there was insufficient evidence to recommend supplemental screening with MRI or ultrasound in women, irrespective of breast density.

Breast cancer remains a significant public health concern, with millions of women worldwide being diagnosed each year. Early detection through screening plays a crucial role in improving survival rates and facilitating timely interventions. However, the optimal age to initiate screening, the frequency of screening mammography, and the utility of additional screening modalities such as magnetic resonance imaging (MRI) have been topics of debate and ongoing research.

A systematic review was commissioned by USPSTF to evaluate the comparative effectiveness of different mammography-based breast cancer screening strategies by age to start and stop screening, modality, screening interval, use of supplemental imaging, or personalization of screening for breast cancer on the incidence of and progression to advanced breast cancer, breast cancer morbidity, and breast cancer-specific or all-cause mortality, and collaborative modeling studies to complement the evidence from the review.

The recommendation updates the 2016 recommendation on breast cancer screening. In 2016, the USPSTF recommended biennial screening mammography for women aged 50 to 74 years and individualizing the decision to undergo screening for women aged 40 to 49 years based on factors such as individual risk and personal preferences and values.

For the current recommendation, the USPSTF recommends biennial screening mammography for women aged 40 to 74 years. The USPSTF again finds that the evidence is insufficient to assess the balance of harms and benefits of supplemental screening for breast cancer using breast ultrasonography or MRI in women identified to have dense breasts on an otherwise negative screening mammogram and the balance of benefits and harms of screening mammography in women 75 years or older. Current evidence suggests that digital mammography and DBT are effective primary screening modalities.

The USPSTF concludes, "the current evidence is insufficient to assess the balance of harms and benefits of supplemental screening for breast cancer using breast ultrasonography or MRI in women identified to have dense breasts on an otherwise negative screening mammogram."

In conclusion, to achieve the benefit of screening and mitigate disparities in breast cancer mortality by ethnicity and race, it is important that all persons with abnormal screening mammography results receive equitable and appropriate follow-up evaluation and additional testing, inclusive of indicated biopsies, and that all persons with breast cancer diagnosis receive effective treatment.

Reference:

US Preventive Services Task Force. Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. Published online April 30, 2024. doi:10.1001/jama.2024.5534