A new set of guidelines released by the U.S. Preventive Services Task Force (PSTF) suggests that women should be screened for breast cancer every other year after they turn 40 years old. The shift away from previous routine mammogram schedules, which began at age 50, aims to reduce cancer-related death rates among women in their 40s, as new evidence suggests an increase in risk for this age group over the last decade — but some experts say this shift isn’t enough.
Previously, only those who had a family history of breast cancer or had irregular biopsies were encouraged to seek out breast cancer screenings before the age of 50. But new evidence highlighted by the PSTF indicates that diagnosis of breast cancer among women in their 40s has increased 2% per year on average between 2015 and 2019 alone, according to the National Cancer Institute. Encouraging those in their 40s (and younger) to seek out screenings may prevent deaths, saving as many as 20% more lives for women affected in this age group, per commentary published by NBC News.
Routine breast cancer screenings nearly always include a mammogram, the minimally invasive process that involves taking an X-ray image of one or both breasts. Alongside other screening questions and medical reviews, the mammogram is often the first line of defense for catching curable breast cancer, explains Rachel Brem, M.D., a leading radiology director at The George Washington University Medical Center and author of the forthcoming breast cancer guide, No Longer Radical.
“Breast cancers in young women grow faster and are more aggressive. The USPSTF finally aligned their age [recommendations] to start screening mammography in average-risk women to align with the enormous amount of data to support it,” she tells Good Housekeeping.
But the updated suggestions from the regulatory board aren’t a first among medical experts calling for earlier screenings for women. The American Cancer Society and the American College of Radiology, among other cancer groups, have previously recommended annual screenings (as opposed to every other year) for women 40 and older.
Dr. Brem is among those experts who believe an annual recommendation is better suited for best results. She says that the current USPSTF recommendations may only impact death rates in a limited scale. “Many lives, especially for younger women, will be lost; women will die from advanced breast cancers, which can be seriously delayed in diagnosis with an every-other-year screening,” she adds.
But there’s also recognition that earlier screenings may better serve women who are in at-risk groups for breast cancer and are simply not being prioritized in healthcare guidance.
How new guidelines may better serve at-risk populations
As acknowledged in the recent PSTF bulletin, Black women are more than 40% more likely to die from breast cancer than white women. “The Task Force recognizes this inequity and is calling for more research to understand the underlying causes, and what can be done to eliminate this health disparity,” the group shared.
Dr. Brem says the disparity exists mainly because there’s uneven access to treatment and screenings, but also due to a genealogical undercurrent, as “Black women get more aggressive, triple-negative breast cancer more frequently.”
Starting screenings at 40 rather than older ages may end up creating more benefits for Black women specifically, as primary care doctors can refer them to screenings or biopsies earlier than before. And since insurance companies often look to guidelines like these to determine coverage, the move to lower the age may help make screenings more affordable.
Having these conversations earlier may work to reduce the care gap in the end, something that experts are well aware of. “Black women have also historically participated in clinical trials less frequently, resulting in less data on personalized treatment for Black women,” adds Dr. Brem, citing another factor that needs to be addressed in the long run.
While the PSTF called for earlier screenings in part to address this disparity, it didn’t take a special stance on women with dense breasts, a characteristic that provides challenges for clinicians — many providers say these individuals also should be screened more frequently. Ultimately, experts are cautious to expose young women to routine radiation to determine breast density, Dr. Brem explains.
“Recommendations should have been more in line with the American College of Radiology, which presses all women in high-risk populations to receive a risk assessment at the age of 25,” Dr. Brem says, adding that healthcare providers can determine if more surveillance and screening is needed in these cases.
“We already know that women in high-risk populations benefit from more intensive screening; we need to screen more women, not to gather more data,” she adds. “The data is definitive already.”
Why doctors say more frequent mammograms, screenings are best
Ultimately, seeking out breast cancer screening is something a patient can prioritize in spite of these guidelines — and many people have historically done so. Data collected by the Centers for Disease Control and Prevention (CDC) indicate that over half of women between the ages of 40 and 49 reported having a mammogram within the last two years. But experts are hoping even more women will seek out cancer screenings with the updated guidelines, which are solely structured for those who are at an average risk of the disease.
Editor’s note: The CDC has a program called the National Breast and Cervical Cancer Early Detection Program, designed to make sure that women who are uninsured, under-insured and/or have low-income get access to screening for these two diseases, as well as diagnostic and treatment help. The program’s interactive map lets you click on your state to get local information.
“Women who have a first-degree relative with breast cancer — a sister or mother — should begin screening five to 10 years earlier than the age at which their family member was diagnosed,” Dr. Brem says. “Women who have family members with known mutations that are associated with an increased risk of breast cancer — or if they themselves have a gene mutation associated with a high risk of breast cancer — should begin screening with MRIs at 25, and with mammography at 30.”
This content is imported from youTube. You may be able to find the same content in another format, or you may be able to find more information, at their web site.
Mammograms are crucial to prevent breast cancer, but they’re not the only tool available. Self-exams are a way to remain vigilant about changes to the breasts that may be noticed during routine activity, or while bathing and getting dressed. It’s worth discussing any concerns with your primary care doctor, because even if you aren’t referred for formal screening, some providers may still offer breast exams and counseling about early detection tactics available to you.
Zee Krstic is a health editor for Good Housekeeping, where he covers health and nutrition news, decodes diet and fitness trends and reviews the best products in the wellness aisle. Prior to joining GH in 2019, Zee fostered a nutrition background as an editor at Cooking Light and is continually developing his grasp of holistic health through collaboration with leading academic experts and clinical care providers. He has written about food and dining for Time, among other publications.