VBCF was encouraged to hear that the US Preventive Services Task Force (USPSTF) is proposing changing their recommendations for mammograms so that women of average risk of developing breast cancer get their mammograms starting at age 40 and continue every other year until 74. We’re going to break down exactly why this is a big deal and a long time coming.
USPSTF is a board of medical experts that analyzes existing research to make recommendations for various screening procedures for people who are at average risk of developing a certain condition. They make recommendations on everything from vaccines, to taking vitamins, to cancer screenings. The Affordable Care Act tied insurance coverage for various preventive health care procedures to the “score” that the USPSTF gives each procedure for how effective it is at reducing the incidence of and mortality for a particular condition. Since 2009, the USPSTF has recommended that women of average risk of breast cancer get mammograms every other year from ages 50 to 74. There are problems with that recommendation, which have since come to light in the research, which have led the USPSTF to propose changing their recommendation.
First, nearly a quarter of Black women with breast cancer are diagnosed before the age of 50. Many of these women would likely have been considered “average risk” for breast cancer since the vast majority of breast cancers are not associated with a family history of the disease. That’s a serious problem, because this means nearly a quarter of Black women with breast cancer fell outside of the guidelines set by USPSTF. Breast cancer research has a history of, and continues to struggle with, recruiting ethnically diverse clinical trial participants and even recording data related to ethnic background as part of the trial. So in the research that USPSTF previously analyzed, the “average” woman was white. This is a concrete illustration of why diverse participation in clinical trials is so important. In the years following the initial recommendation, there has been a wave of growing evidence that Black women are more likely to be diagnosed younger and with more aggressive forms of breast cancer, making this update in USPSTF recommendations absolutely necessary.
Second, as stated in numerous news articles, breast cancer cases in younger women have increased by 2% each year recently. This is a disturbing trend because regardless of ethnic background, breast cancer at a younger age is more likely to be aggressive and more difficult to treat, and it also comes with a longer list of complications and long-term effects due to the early age of diagnosis. For these reasons, we’d ideally have the screening recommendations be annual from the ages of 40-49, but we’ll still take the lowering of the starting age to 40 as a step in the right direction.
Third, most professional medical groups and cancer advocacy organizations disagreed with the recommendations. The American College of Obstetricians and Gynecologists and the American College of Radiology kept their recommendations at 40. American Cancer Society stated that women should have access to mammograms at 40 but should start no later than 45. VBCF, for the record, never changed our recommendation from 40.
Fourth, even Congress ignored the recommendation. Since the USPSTF recommendation was released, Congress passed a bill to ensure that women can receive a screening mammogram covered at no cost by insurance, every year, starting at the age of 40. Without this bill, women under 50 with insurance wouldn’t have been able to get free mammograms, and that means fewer women would have gotten screened, and the country would have seen even more late-stage diagnoses and likely seen more deaths due to breast cancer.
And finally, one of the talking points around beginning breast cancer screenings at 50 was to reduce the stress and worry that comes with an abnormal finding on a mammogram and subsequent testing. Let’s be clear: it is stressful and can be scary to get a call saying that there was an abnormal finding, and you have to go back for additional testing to check for breast cancer. However, women, as is the case with men, should have medical tests recommended, or not recommended, to them based upon science and not a presumptive emotional reaction by the patient.
This change to the USPSTF recommendation for mammograms brings it more in line with the current research and the state of breast cancer in our country. Science moves fast these days, and we need our official agencies to be nimble in order to adapt to new information as it comes in so that we can make the most of it. We’re also glad it will no longer require an act of Congress for women to get their free breast cancer screenings starting at 40.
