Apr 30, 2024 - Health

U.S. panel, cancer groups differ on new breast cancer screening guidelines

Illustration of a clock with hands made from a pink breast cancer ribbon.

Illustration: Annelise Capossela/Axios

An influential national advisory group has called for women to start getting mammograms beginning at age 40, but only every two years  — a recommendation that highlights a rift within the cancer community

Why it matters: The U.S. Preventive Services Task Force recommendations will serve as a critical signal to doctors and influence insurance coverage.

Driving the news: The panel's guidelines, finalized Tuesday, lowered the recommended screening age for all women from 50 to 40, and said women up to age 74 benefit from biennial breast cancer screening.

  • The approach has the potential to save about 20% more lives, it said.
  • The panel said the benefits of screening for women 75 and older remain unclear and that more evidence is needed to support additional screening with imaging technology for women with dense breasts.

Friction point: While experts from the American Cancer Society, Susan G. Komen and other groups applauded the lowered screening age, they said failure to recommend annual mammograms and additional screening options for higher-risk patients will lead to more cases of cancer being detected later.

  • "Younger women are more likely to have some degree of breast density and, probably, their tumors grow a little bit faster and so that's why there's an advantage to screening more frequently," said Robert Smith, senior vice president of early cancer detection science at the American Cancer Society.

In particular, Black women have higher rates of aggressive cancers at younger ages than white women.

  • Overall, Black women are 40% more likely to die of breast cancer than white women, according to the task force, which said more research is needed to understand the disparity.

Between the lines: Insurers will be required to cover the task force's recommendation, but advocates worry that higher-risk patients, such as those with dense breasts, could still be left with high out-of-pocket costs.

  • Those women often need supplemental screening, such as MRIs or ultrasounds. In most states, those costs are paid entirely by the patient, said Komen vice president of policy and advocacy Molly Guthrie
  • "It's just really unfortunate that we are still fighting the fight to ensure all people can afford and get access to the screening that they need, whether that be a mammogram or something else," she said.
  • Advocates say they also worry about the lack of a recommendation for screening for women 75 and above.

What they're saying: The panel looked at numerous studies and said it weighs what it can definitively say about the benefits and harms of care based on the available science, task force chair Wanda Nicholson told Axios.

  • "The latest science continues to show that when you balance lives saved against potential harms of screening — like unnecessary follow-ups or treatments or unnecessary biopsies — the best balance of benefits and harms is when screening is performed every other year," Nicholson told Axios.
  • For instance, when it comes to women 75 and older, the panel isn't recommending against screening but said it doesn't have enough evidence for or against it.

This isn't the first time there's been disagreement over the task force's breast cancer screening recommendations.

  • The panel in 2009 raised the recommended age to 50, while advising that women starting at age 40 consult with their doctor about possibly screening earlier.
  • But that caused so much controversy that Congress took action, moving to make sure women could continue to get mammogram coverage starting at 40.

Editor's note: This story was updated to clarify that the panel in 2009 recommended that most women start breast cancer screenings at age 50 and that women starting at age 40 should consult their doctor about screening.

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