In April of last year, the U.S. Preventive Services Task Force (USPSTF) issued a new set of draft recommendations on the use of mammography to screen for breast cancer, reiterating its 2009 "B" recommendation(www.uspreventiveservicestaskforce.org) to screen women ages 50-74 for breast cancer using mammography every two years.
After a comprehensive review of evidence on the benefits and harms of screening mammography, as well as input received from the public and health care professionals on its draft recommendation, the USPSTF now has affirmed that stance in its final recommendation statement,(www.uspreventiveservicestaskforce.org) which was released Jan. 12.
In that final statement, the task force continues to recommend that the decision to screen women younger than 50 be individualized, weighing the benefits and harms of screening. In this instance, women who place a higher value on the potential benefit than the potential harms may choose to initiate screening mammography every two years between ages 40 and 49 -- a "C" recommendation.
Finally, the USPSTF also concluded that there is insufficient evidence to recommend for or against screening women 75 or older ("I" recommendation).
- The U.S. Preventive Services Task Force has finalized its recommendation that women ages 50-74 at average risk for breast cancer undergo screening mammography every two years.
- The task force continues to recommend that the decision to screen women younger than 50 be individualized, weighing the benefits and harms of screening.
- The AAFP's breast cancer screening recommendations mirror those of the USPSTF.
"The task force, the American Cancer Society and many others have all affirmed that mammography is an important tool to reduce the risk of dying from breast cancer, and that the benefits of mammography increase with age," said USPSTF Chair Albert Siu, M.D., M.S.P.H., in a news release.(www.uspreventiveservicestaskforce.org) "We hope this growing convergence among distinct organizations gives women and their health care providers confidence in the science that supports mammography screening."
According to AAFP President Wanda Filer, M.D., M.B.A., of York, Pa., the Academy agrees with the USPSTF's recommendations.
"Women attain the greatest benefit from mammography starting at age 50," Filer said. "Women ages 40-49 attain less benefit with more risk, but should have the option of getting a mammogram after they discuss the risks and benefits with their personal physician."
In its recommendation statement, the task force also identified areas in which additional research is needed to better understand how screening might reduce breast cancer deaths.
Specifically, the USPSTF for the first time assessed the effectiveness of digital breast tomosynthesis (DBT), or three-dimensional mammography, for the detection of breast cancer, as well as adjunctive screening using ultrasonography, MRI, DBT or another modality in women with dense breasts in whom screening mammography is negative. In each of these instances, task force members concluded that evidence is insufficient to determine the balance of benefits and harms.
The AAFP's breast cancer screening recommendations mirror those of the USPSTF.
Before 2009, the USPSTF recommended mammography every one to two years starting at age 40. So, when the 2009 recommendation came out focusing on screening women ages 50-74, concerns surfaced that it could lead to missed screening opportunities and subsequent breast cancer deaths.
Further complicating the picture, said Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, in an April AAFP News story is the variance in breast cancer screening recommendations proffered by other organizations, such as the American Congress of Obstetricians and Gynecologists, and the American College of Radiology, which have continued to recommend annual breast cancer screening beginning at age 40.
And although the American Cancer Society (ACS) at the time joined those two groups in recommending that screening start at age 40, the ACS has since shifted its stance and now recommends that women at average risk for breast cancer begin annual screening mammography at age 45 and transition to screening every two years at age 55.
The most recent development, however, has been on the legislative stage. As part of the Consolidated Appropriations Act, 2016(www.congress.gov) that Congress passed in December, federal lawmakers extended a guarantee originally included in the Patient Protection and Affordable Care Act (ACA) that directed most health plans to fully cover screening mammography with no cost sharing for women who choose to begin screening at age 40.
It should be noted that by allowing no-cost screening to start at age 40, this ACA provision broadens the law's overarching directive that all services that receive an "A" or "B" recommendation from the USPSTF are to be covered with no copay.
Related AAFP News Coverage
USPSTF Draft Recommendation
Women at Risk for Breast Cancer Should Participate in Decisions About Risk-reducing Drugs