USPSTF recommends biennial breast cancer screening for women ages 40 to 74 years
The new U.S. Preventive Services Task Force (USPSTF) screening recommendations on mammography represent a change for women aged 40 to 49 years, who in 2016 were advised to make individual decisions about screening.
Women ages 40 to 74 years should undergo screening mammography every two years, according to updated recommendations from the U.S. Preventive Services Task Force (USPSTF).
The Grade B recommendation is based on a systematic review evaluating the comparative effectiveness of different mammography-based breast cancer screening strategies, among other factors. An assessment of the evidence concluded with moderate certainty "that biennial screening mammography in women aged 40 to 74 years has a moderate net benefit," the USPSTF said in updated recommendations published by JAMA on April 30.
The statement also notes current evidence is insufficient to assess the balance of benefits and harms of mammogram screenings in woman aged 75 years and older (Grade: I statement). Evidence is also insufficient for supplemental screening for breast cancer using breast ultrasonography or MRI in women identified to have dense breasts on an otherwise negative screening mammogram (Grade: I statement). "Clinicians should use their clinical judgment" on these questions, the authors wrote.
The recommendations represent a change from the 2016 USPSTF update, in which breast cancer screening for women aged 40 to 49 years got a C recommendation, indicating that the decision to undergo screening for women in this age group should be individualized.
Recommendations apply to cisgender women and all other persons female at birth with average risk of breast cancer. They also apply to those with certain factors associated with a higher risk of breast cancer, including individuals who have a family history of breast cancer (i.e., a first-degree relative with breast cancer) or dense breasts. Recommendations do not apply to those with a genetic marker or syndrome associated with a high risk of breast cancer (e.g., BRCA1 or BRCA2 genetic variation), a history of high-dose radiation therapy to the chest at a young age, previous breast cancer, or a high-risk breast lesion on previous biopsies, the authors noted.
Effective mammography screening modalities include digital mammography and digital breast tomosynthesis (DBT, or "3D mammography"), although "DBT must be accompanied by traditional digital mammography or synthetic digital mammography," the statement said. The latest recommendations reflect evidence showing biennial screening has a better balance of benefits versus harms compared with annual screening, the USPSTF noted.