Women should get regular mammograms starting at age 40, expert panel says

By Eleanor Laise

The new recommendations come as breast-cancer rates rise among younger women

Women should get mammograms every two years from age 40 through 74, the U.S. Preventive Services Task Force said in newly finalized recommendations issued Tuesday.

While biennial mammograms for women aged 40 to 74 have a "moderate net benefit," there's not enough evidence to recommend the breast-cancer screening test for women 75 and older, the independent panel of disease-prevention experts said in its recommendations published Tuesday in JAMA.

Breast cancer is the second-most common cause of cancer deaths among women in the U.S., killing an estimated 43,000 last year. Yet about one-third of women facing job loss, a lack of transportation and similar issues are skipping potentially lifesaving mammograms, according to a recent report from the U.S. Centers for Disease Control and Prevention.

The new recommendations, which finalize draft guidelines that the task force published last spring, come as breast-cancer rates are rising among younger women. The incidence of breast cancer among women aged 40 through 49 rose gradually from 2000 to 2015 but grew more noticeably from 2015 to 2019, to the tune of a 2% average annual increase, the task force said in its recommendation statement.

The guidelines represent a significant shift from the preventive-services task force's previous recommendation issued in 2016 - which suggested that women should start receiving biennial mammograms starting at age 50, and that women aged 40 to 49 should consider getting the screening test based on their individual risks and preferences.

The task force said the new recommendations apply to people at an average risk of breast cancer - not those who have genetic markers putting them at high risk of the disease, a history of high-dose radiation therapy to the chest at a young age, or who have previously had breast cancer.

Some other groups recommend that women receive mammograms more frequently. The American Cancer Society suggests that women aged 45 to 54 should get mammograms every year, while the American College of Obstetricians and Gynecologists recommends screenings every one to two years starting at age 40.

The preventive-services task force said that it weighed screening benefits against potential risks - most notably, false-positive results, which could lead to psychological harm or additional testing and invasive follow-up procedures without any potential benefit. Research suggests that false-positive results are more likely to occur with annual screenings than with longer intervals, the task force said.

More research is still needed to understand and address higher breast-cancer mortality rates among Black women, the task force said, as well as whether the benefits of annual versus biennial screenings might differ for those women. Despite having mammograms at similar or higher rates than women of other racial and ethnic groups, Black women are more likely than white women to be diagnosed with more aggressive tumors and about 40% more likely to die of breast cancer, according to the task force.

For women with dense breasts - a factor linked with increased risk of breast cancer - there's not enough evidence to recommend supplemental screening using ultrasounds or MRIs after a negative result on a screening mammogram, the task force said. But there is "an urgent need for better evidence" on the topic, Joann Elmore, a professor of medicine at the University of California, Los Angeles, and Christoph Lee, a radiology professor at the University of Washington, wrote in an editorial also published Tuesday in JAMA. The issue is of "critical concern," the professors said, as the U.S. Food and Drug Administration is requiring that mammography facilities inform women about their breast density with their mammogram results starting in September of this year.

More research is also needed on artificial-intelligence support tools for interpreting mammogram images, Elmore and Lee said. While AI algorithms show promise for improving cancer detection, they wrote, "their impact on patient outcomes and the balance between benefit and harms remain uncertain." One concern, the professors noted, is that the tools could be swiftly adopted before there's enough data to justify their use at the population-screening level.

-Eleanor Laise

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04-30-24 1100ET

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