Executive Summary
The U.S. Preventive Services Task Force has released draft health recommendations indicating that mammography screening is most beneficial for women ages 50-74 and that women ages 40-49 should make an individual decision with their doctors in seeking such screening.
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Based on the evidence, the Task Force found that the benefit of mammography screening increases with age, with women ages 50 to 74 benefiting most. Women get the best balance of benefits to harm when screening is done every two years, the group concludes.
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While 3-D mammography offers promise as a new breast cancer detection tool for, the Task Force did not find enough evidence to determine whether it will result in better overall health outcomes for women. It did not issue a recommendation on the practice.
The U.S. Preventive Services Task Force has released draft health recommendations indicating that mammography screening is most beneficial for women ages 50-74, and that women ages 40-49 should make an individual decision in partnership with their doctors in seeking such screening. Based on the evidence, the Task Force found that the benefit of mammography screening increases with age, with women ages 50 to 74 benefiting most. Women get the best balance of benefits to harm when screening is done every two years, the group concludes.
“Mammography is an important tool in reducing the number of breast cancer deaths,” said Michael LeFevre, MD, MSPH, the Task Force’s immediate past chair, in a statement. “Based on the evidence, the Task Force found that screening is most beneficial for women ages 50 to 74.”
How should providers approach women with this new information on mammograms?
As women, in concert with their providers, are deciding when to start and how often they should obtain a mammogram, they deserve to know what the evidence says about the potential benefits and the potential harms, explains Kirsten Bibbins-Domingo, PhD, MD, Task Force vice chair. The Task Force found that screening every other year starting at age 50 can have an important beneficial impact on women’s lives, she notes. “When we think about screening more often and in younger women, it’s important to consider that there is still a benefit, but there are also significant harms,” states Bibbins-Domingo. “Because of this, the Task Force recommends that women and their doctors discuss these benefits and harms to decide if screening is right for them.”
Fortunately, breast cancer is an uncommon disease for women under 50, observes Bibbins-Domingo. Despite this fact, the Task Force found an important benefit of mammograms is that they can help women in their 40s reduce their risk of dying from breast cancer. However, in comparison to women in their 50s and 60s, the number of women in their 40s who will benefit is much smaller, and the likelihood of harm is greater than at older ages, notes Bibbins-Domingo.
“Of the potential harms, the most serious is unneeded treatment for a type of cancer that would not have become a threat to a woman’s health during her lifetime,” she says. “The most common is a false-positive test result, which often leads to additional tests and procedures and may lead to anxiety and stress.”
If a woman between age 40 and 49 places a higher value on the potential benefit than the potential harms, she might choose to begin screening, states Bibbins-Domingo. Women who have a mother, sister, or daughter with breast cancer might benefit more than average-risk women by beginning screening in their 40s. The Task Force’s goal with the draft recommendations is to inform and empower women and their doctors with the best scientific data about the benefits and harms associated with breast cancer screening, so they can make an informed decision that best reflects their personal values, states Bibbins-Domingo.
Where do professional societies stand on the issue? The American Cancer Society recommends annual screening starting at age 40 and continuing as long as the woman is in reasonably good health and a candidate for treatment. The American College of Physicians advises that for women ages 40-49, screening mammography decisions should be made of the basis of individualized assessment of risk for breast cancer. The American College of Obstetricians and Gynecologists, the American College of Radiology, and the Society for Breast Imaging recommend that women begin annual screening mammography at age 40.1
The Task Force also developed several additional recommendations as part of its draft recommendation statement. For women age 75 and older, the Task Force determined that the current evidence is insufficient to make a recommendation for or against mammography screening. The Task Force is encouraging more research on screening in this group.
While 3-D mammography offers promise as a new technology for the detection of breast cancer, the Task Force did not find enough evidence to determine whether it will result in better overall health outcomes for women. Based on the current paucity of research, the Task Force was unable to make a recommendation for or against 3-D mammography.
“There are promising new technologies to detect breast cancer, but there is just not enough evidence available at this time for the Task Force to clearly evaluate the balance of benefits and harms, and therefore, we cannot make a recommendation for or against these technologies,” says Bibbins-Domingo. “Mammography is a good test, but not a perfect test, and we need better tests and better treatments to truly beat this disease.”
Evidence to recommend a specific screening strategy for women with dense breasts is insufficient, the Task Force says. Women who have dense breasts are at an increased risk for breast cancer, and high breast density also reduces the ability of mammography to find and accurately identify breast cancer. However, the evidence on how additional screening beyond mammography might or might not help women with dense breasts is unclear, the group said. Additional research is needed in this area, the Task Force states.
To help educate healthcare professionals, stakeholders, and the general public about the draft recommendations, the Task Force has developed additional materials, including a myth-versus-fact slide set, a video, answers to frequently asked questions (FAQs), and a fact sheet for consumers. Check out these materials at http://screeningforbreastcancer.org. The video is on the home page. The slide set is at http://bit.ly/1eaRhX6. The FAQs are at http://bit.ly/1cKUDzf, and the consumer fact sheet is at http://bit.ly/1IH5M1A.
1. Nelson R. USPSTF updates its breast cancer screening recommendations. Accessed at http://wb.md/1Ht5hGj.
