U.S. Preventive Services Task Force changes breast cancer screening guidelines

The independent panel of experts that systematically develops recommendations for clinical preventive services now recommends mammograms every other year for women starting at age 40.

By Diane Mapes

Oops, they did it again — that is, the U.S. Preventive Services Task Force once more changed their screening recommendations for breast cancer.

In 2016, the USPSTF recommended breast cancer screening start at age 50 and continue every other year until age 74. They also recommended anyone in their 40s who wanted screening to discuss risk with their doctor.

New guidelines, published Tuesday in JAMA, now recommend breast cancer screening start at age 40 and continue every other year until age 74 to better serve younger women.

The latest data, which span 2015 to 2019, show a 2% increase in breast cancer diagnoses per year among women in their 40s.

Janie Lee, MD, MSc, Fred Hutch Cancer Center’s director of breast imaging, said the recommendations align with those of both Fred Hutch and UW Medicine.

“We have joint breast cancer screening guidelines across both organizations and across departments — primary care, radiology and breast oncology,” she said. “The consensus recommendation endorses beginning screening at age 40.”

Lee, who acknowledged the havoc often caused by changing guidelines, said she was optimistic about these recommendations, mainly because they “better align with other groups that issue breast cancer screening guidelines.”

“With more clear consensus across guidelines, I hope there will be less confusion among women about breast cancer screening,” she said. “The scientific evidence is clear that mammography saves lives.”

So many guidelines, so many changes!

Cancer screening guidelines are issued by several large national organizations: the USPSTF and the American Cancer Society are the most well-known. But other groups, like the American College of Radiology, the Society of Breast Imaging, and National Comprehensive Cancer Network, or NCCN, also regularly issue, and update, cancer screening guidelines.

Unfortunately, these guidelines don’t always agree.

Case in point: the American Cancer Society’s guidelines for breast cancer screening recommend yearly mammograms from age 45 until menopause, then they’re every other year. Read the full ACS breast screening guidelines here. Previous ACS guidelines recommended annual mammograms starting at age 40.

This latest update means most of the organizations are now on the same page. The American College of Radiology, the Society of Breast Imaging, the American College of Obstetricians and Gynecologists and the NCCN all recommend mammography screening start at age 40 for women at average risk. 

Why do they flip back and forth all the time? Lee said it’s because new information continues to roll in from ongoing studies and clinical trials.

“Since the USPSTF guidelines were last issued in 2016, new trials have reported results,” she said. “There has been more specific evaluation of digital breast tomosynthesis, also known as 3D mammography. Guidelines change in part because information changes.”

As for the differing opinions, each organization has their own focus, according to Fred Hutch biostatistician Ruth Etzioni, PhD, who’s served on various guidelines committees. Etzioni is the holder of the Rosalie and Harold Rea Brown Endowed Chair.

“The USPSTF is predominantly made up of primary care doctors and, thus, is concerned with the whole, healthy population,” she said. “The American Cancer Society is all about reducing death from cancer, so their guidelines have traditionally been more rigorous.”