USPSTF Releases New Breast Cancer Screening Guidelines

Sponsoring Organization: U.S. Preventive Services Task Force (USPSTF)

Background

Screening mammography lowers breast cancer–related mortality, but incidence of invasive breast cancer is increasing among women in their 40s. Compared with white women, Black women are more likely to develop aggressive cancers at younger ages and are at higher risk for breast cancer–related mortality. In 2016, the USPSTF recommended biennial mammograms for middle-aged women (age range, 50–74; grade B) with individualized decision making for those who were 40 to 49 (grade C; NEJM JW Gen Med Feb 1 2016 and Ann Intern Med 2016; 164:279). Now, the Task Force has updated this guideline.

Key Recommendations

These recommendations apply to all people assigned female at birth and at average risk for breast cancer.

• The USPSTF recommends biennial screening mammograms for women who are 40 to 74 (grade B) and concludes with moderate certainty that such screening has net benefit in preventing breast cancer–related mortality.
• In women who are 75 or older, evidence is insufficient to recommend for or against screening.
• For women with dense breasts, the Task Force found inadequate evidence to make a recommendation on benefits and harms of supplemental screening with ultrasound or magnetic resonance imaging after negative mammography.

What's New

For women in their 40s, the USPSTF previously recommended shared decision making about screening but stopped short of formally recommending it; now, they recommend screening all women in this age group. A decision analysis estimates this change will avert 1.3 additional breast cancer–related deaths per 1000 women screened biennially during a lifetime of screening — at the expense of an approximately 60% increase in false-positive results.