Images show AI detecting breast cancer 4 years before it developed
02:38 - Source: CNN
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The US Preventive Services Task Force is proposing that all women at average risk of breast cancer start screening at age 40 to reduce their risk of dying from the disease, according to a new draft recommendation statement.
It’s an update to the 2016 recommendation, in which the task force recommended that biennial mammograms, which are x-rays of the breasts, start at age 50 and that the decision for women to screen in their 40s “should be an individual one.”
Some groups, such as the American Cancer Society, already have been recommending for women to start mammograms in their 40s.
“Our new task force recommendation is recommending that women start screening with mammography for breast cancer at age 40 and screen every other year until age 74,” said USPSTF Vice Chair Dr. Wanda Nicholson, a senior associate dean and professor at George Washington University’s Milken Institute School of Public Health.
The USPSTF, a group of independent medical experts whose recommendations help guide doctors’ decisions and influence insurance plans, released the proposed update to its breast cancer screening guidance Tuesday. The recommendation is not final but will be available on the task force website for public comment through June 5, along with a draft evidence review and draft modeling report.
The draft recommendation is for all people assigned female at birth, including cisgender women, trans men and nonbinary people, who are at average risk for breast cancer.
Nicholson said that women with dense breasts and those with a family history of cancer generally fall into this category but not women who have a personal history of breast cancer or a family history of genetic mutations, like mutations on the BRCA gene, as they are considered to be at high risk.
The updates would not apply to those at an increased risk of breast cancer, who may already have been encouraged to screen at 40 or earlier. They should continue to follow the screening practices that their doctors have recommended.
Breast cancer is the second most common cancer among women in the United States, and rates of death are highest among Black women.
‘Screening alone is not enough’
The update to the recommendation “will save more lives among all women,” Nicholson said. “And this is particularly important for Black women, who are 40% more likely to die from breast cancer.”
The draft recommendation comes a few weeks after a study in the journal JAMA Network Open found that the rate of breast cancer deaths among women in their 40s was 27 per 100,000 person-years for Black women, compared with 15 deaths per 100,000 in White women and 11 deaths per 100,000 in American Indian, Alaska Native, Hispanic and Asian or Pacific Islander women. The researchers suggested that Black women start screening at younger ages, around 42 instead of 50.
The USPSTF members are calling for more research into these racial inequities in breast cancer, Nicholson said, and for all women who get abnormal mammogram results to receive equitable follow-up evaluations, additional testing, biopsies and treatment when needed.
“Screening alone is not enough. Once someone screens with an abnormal mammogram, the subsequent steps in care must occur – timely follow-up, biopsies that are indicated – and Black women must have access to equitable treatment,” she said.
“We’re calling for more research to look across the health systems as to why these inequities occur,” she said, adding that the draft recommendation also calls for more research into whether women with dense breasts should get additional screening and among “women who are 75 years of age and older, whether and how to screen that population.”
Cases in younger people
To review and update breast cancer screening guidance, the task force members analyzed data from thousands of study abstracts and hundreds of research papers on screening programs, cancer cases and deaths in the United States.
They found that screening with mammograms every other year provided a moderate benefit to women ages 40 to 74, as the benefits, such as detecting cancer early, outweigh potential harms, such as the risk of a false positive that could lead to unnecessary tests and emotional stress.
The evidence is “insufficient” to determine the risks and benefits for screening in women 75 and older, the group determined.
The task force also noticed that the rate of breast cancer diagnoses has been rising each year among women at younger ages.
Population-based data “showed that the rate of breast cancer diagnoses was increasing at 2% annually since 2015. So more women than ever before are being diagnosed in their 40s,” Nicholson said.
An estimated 12.9% of women born in the United States today will develop breast cancer at some time during their lives, according to the National Cancer Institute.
“Within our recommendation, we’re calling for more research to have a better understanding of the causes and mechanisms that may be contributing to breast cancer development in all women, and in particular among Black women,” she said. “We know that Black women continue to have more aggressive tumors.”
A paper published in October in the journal Nature suggests that the incidence of various cancers diagnosed in adults 50 and younger has been rising in many parts of the world since the 1990s.
“The rising incidence of early-onset cancers is probably partially attributable to increasing uptake of screening and early detection before the age of 50 years, to variable degrees across certain cancer types, especially breast, prostate and thyroid cancers,” the researchers wrote.
“However, increasing incidence of early-onset cancers in several organs, such as colorectal and pancreatic cancers, which might not be fully explained by screening is also apparent,” the researchers wrote. “This trend could reflect increased risk factor exposures in early life and/or young adulthood.”
To screen biennially or annually?
The draft recommendation appears to be catching up with what other organizations have been recommending for some time.
It aligns more closely – but not entirely – with American Cancer Society recommendations that women ages 40 to 44 have the option to screen with a mammogram every year, women 45 to 55 get mammograms every year, and women 55 and older can switch to a schedule of mammograms every other year.
“There are some similarities and some differences. So, now, the new task force recommendations has changed from screening at age 50 to age 40. And our recommendations currently are that women should begin to have the opportunity to begin annual screening if they choose beginning at age 40. The big difference there is, we recommend annual screening at that age, while the task force recommends biennial screening,” said Dr. William Dahut, chief scientific officer of the American Cancer Society, who was not involved in the USPSTF draft recommendation.
“But the big thing is, I think, a lot of women were being screened probably starting in their 40s, and so this is consistent, I think, with how most women and practitioners have been looking at screening,” he said.
Both the USPSTF and the American Cancer Society recommendations are for women at average risk. Dahut said that women should talk to their doctors about whether they might have a higher risk for breast cancer and what screening practices would be best for them, including factors like a family history of ovarian or breast cancer or dense breasts, which have less fatty tissue and more connective tissue and have been associated with a higher risk of breast cancer.
“The change in guidelines by the USPSTF to endorse screening mammograms for average risk women 40 and over is warranted, incorporates more modern and ‘real world’ data into the science informing the guidelines and will hopefully prompt payers to provide better coverage for women seeking breast cancer screening,” Dr. Laura Dominici, a breast cancer surgeon at Dana-Farber/Brigham and Women’s Cancer Center, said in an emailed statement. She was not involved in the USPSTF draft recommendation.
“This is particularly important related to racial disparities in screening, as Black women are more likely to develop aggressive cancers at younger ages, contributing to worse outcomes,” Dominici said. “I am glad to see inequities in screening being acknowledged, but more attention to this will be needed in future guidelines.”
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Still, the new draft recommendation will not change how Dr. Maxine Jochelson discusses breast cancer risks and the important of screening with her patients, she said.
“Unfortunately, the fact that they’re still recommending every other year rather than yearly screening, and in particular in the younger population, is very disappointing,” said Jochelson, chief of the breast imaging service at Memorial Sloan Kettering Cancer Center in New York, who was not involved in the USPSTF draft recommendation.
“You are going to miss earlier cancers if you’re waiting longer, and younger women and Black women often have more aggressive cancer,” she said. “I’m going to still tell them to have yearly screening.”
FAQs
Does the American Cancer Society recommend that starting at age 40 women should have a mammogram? ›
The American Cancer Society recommends women have the option to start yearly screenings between ages 40 to 44 and have annual mammograms starting at age 45. But there can be issues if people undergo screening too early,.
Why does breast cancer screening start at 50? ›Why does screening not start until the age of 50? Research studies have shown that screening significantly reduces deaths from breast cancer in women aged 50 to 70 years who attend for screening. For women under the age of 50 the effectiveness of screening is controversial.
What age should women start screening for breast cancer? ›Mammogram age recommendation lowered from 50 to 40
Women should get screened for breast cancer every other year starting at age 40, according to draft guidance issued Tuesday by the U.S. Preventive Services Task Force.
Women of all racial and ethnic backgrounds who are at average risk for breast cancer should start getting regular mammograms at age 40, instead of treating it as an individual decision until they are 50, as previously recommended, the U.S. Preventive Services Task Force said.
Should I get a mammogram at 40 or 50? ›Answer From Sandhya Pruthi, M.D. At Mayo Clinic, health care professionals offer mammograms starting at age 40. Most people should have a mammogram every year. When you should begin mammograms for breast cancer screening is something for you and your health care team to consider.
Why are mammograms not recommended for women under 40? ›“While a majority of breast cancers that are found during annual breast cancer screening mammograms are in women over 50, women under 40 are generally too young to begin screening unless they have a mutation, a genetic reason or have physical symptoms, such as a mass or other breast changes,” explains breast oncologist ...
Where do between 50% 75% of breast cancers begin? ›Between 50 and 75 percent of breast cancers begin in the milk ducts, 10 to 15 percent begin in the lobules and a few begin in other breast tissues [4].
Should I get a mammogram at 45 or 50? ›Benefits of screening mammography for women ages 40-49
The American Cancer Society states women should have the option to have a mammogram every year, starting at age 40 [8]. It recommends routine screening mammography starting at age 45 [8].
Summary of Recommendations
Women at average risk of breast cancer should initiate screening mammography no earlier than age 40 years. If they have not initiated screening in their 40s, they should begin screening mammography by no later than age 50 years.
To have screening you have an x-ray of your breast called a mammogram. Breast screening is for women between the ages of 50 and 70, it is also for some trans or non-binary people.
What age should you get a cancer screening? ›
Regular screening, beginning at age 45, is the key to preventing colorectal cancer and finding it early. The U.S. Preventive Services Task Force (Task Force) recommends that adults age 45 to 75 be screened for colorectal cancer. The Task Force recommends that adults age 76 to 85 talk to their doctor about screening.
At what age does breast screening stop? ›You'll automatically get your first invite for breast screening between the ages of 50 and 53. Then you'll be invited every 3 years until you turn 71.
How often should a woman over 40 get a mammogram? ›Ages 40 to 44: Should consider having a mammogram every year with your decision informed by a shared decision making process with your health care provider. During this process, they will explain the benefits and harms of screening. Ages 45 to 54: Have a mammogram every year.
How often should a 42 year old woman get a mammogram? ›Women age 40 to 44 should have the choice to start annual breast cancer screening with mammograms if they wish to do so. Women age 45 to 54 should get mammograms every year. Women age 55 and older should switch to mammograms every 2 years, or can continue yearly screening.
Should women over 40 have mammography once every two years? ›New guidelines say women should begin getting regular mammograms every two years starting at age 40 if they are at average risk of breast cancer. That's a significant change from previous guidance by the U.S. Preventive Services Task Force that said women could start routine mammograms at 50.
Can you wait until 50 for a mammogram? ›The American Cancer Society says women ages 45 to 54 should get mammograms every year—but can choose to start at 40 and then at 55, can choose to switch to every other year.
What are the benefits of mammography for an average 40 year old female? ›The primary benefits of screening for women in their 40s are a reduction in breast cancer mortality, years of life lost to breast cancer, and morbidity of breast cancer treatment by detecting cancers at an earlier stage.
Are most breast cancers diagnosed after age 50? ›Risk Factors You Cannot Change
Most breast cancers are diagnosed after age 50. Genetic mutations. Women who have inherited changes (mutations) to certain genes, such as BRCA1 and BRCA2, are at higher risk of breast and ovarian cancer.
Most breast cancers develop in the upper outer quadrant of the breast, closest to the armpit. This is because this area has a lot of glandular tissue.
Where do most breast cancers begin? ›Most breast cancers begin in the ducts or lobules. Breast cancer can spread outside the breast through blood vessels and lymph vessels.
Why no mammogram after 75? ›
In women 75 to 84, screening did not substantially reduce the risk of dying from breast cancer. The reason is likely that by 75, women are more likely to die from heart disease or neurological diseases such as dementia than breast cancer, the authors said.
Can a 35 year old woman get a mammogram? ›A very common question asked is, “what age should a woman get a mammogram?” Generally, mammograms are recommended for women aged 40 to 50, but you can get a mammogram at 35 if you have genetic mutations or a family history of cancer.
How often do you need a Pap smear after 40? ›After the first test: Women ages 30 through 65 should be screened with either a Pap test every 3 years or the HPV test every 5 years or both tests every 5 years (called “cotesting”).
How do you know if you have breast cancer at 40? ›- New lump in the breast or underarm (armpit).
- Thickening or swelling of part of the breast.
- Irritation or dimpling of breast skin.
- Redness or flaky skin in the nipple area or the breast.
- Pulling in of the nipple or pain in the nipple area.
Women who refuse mammography based on concerns about radiation or other factors (for example, pain/discomfort from compression) should be counseled on the safety of mammography, the low risks of the radiation associated with mammography, and the success of mammography as a screening test.
Why are clinical breast exams no longer recommended? ›The American Cancer Society no longer recommends CBEs or BSEs for women with an average risk for breast cancer because research has not associated them with clear benefits in settings where mammography screening is available and awareness is high.
Should a woman begin mammogram screenings at the age of 45 years old? ›Women ages 40 to 44 should have the choice to start annual breast cancer screening with mammograms (x-rays of the breast) if they wish to do so. Women age 45 to 54 should get mammograms every year. Women 55 and older should switch to mammograms every 2 years, or can continue yearly screening.
Is cancer screening a good idea? ›Cancer screenings are recommended because there's evidence that early diagnosis can lead to better treatment outcomes. In some cases, like with breast cancer, cancer can be cured completely if caught early.
What are the recommendations for breast screening? ›For women at average risk (ie <1.5 times population risk) of breast cancer, most of the benefit of a mammogram will result from biennial screening during ages 50–74 years of age. Of all age groups, women aged 60–69 years are most likely to avoid a breast cancer death through mammogram screening (C).
At what age are most cancers diagnosed? ›A similar pattern is seen for many common cancer types. For example, the median age at diagnosis is 62 years for breast cancer, 67 years for colorectal cancer, 71 years for lung cancer, and 66 years for prostate cancer. But cancer can be diagnosed at any age.
At what age can you skip mammograms? ›
For women with no history of cancer, U.S. screening guidelines recommend that all women start receiving mammograms when they turn 40 or 50 and to continue getting one every 1 or 2 years. This routine continues until they turn about 75 years of age or if, for whatever reason, they have limited life expectancy.
Does a 75 year old woman need a Pap smear? ›Women over 65 may hear conflicting medical advice about getting a Pap smear – the screening test for cervical cancer. Current medical guidelines say the test is not necessary after age 65 if your results have been normal for several years.
Why is breast screening every 3 years? ›Is this often enough? Evidence has shown that screening once every 3 years is more effective than screening once every year. We therefore recommend that women attend for breast screening once every 3 years.
Do mammograms start at 40 or 45? ›The American College of Obstetricians and Gynecologists recommends that women at average risk of breast cancer should get a mammogram every 1 to 2 years, beginning at age 40. So, the new draft recommendation from the U.S. Preventive Services Task Force brings the screening recommendations into alignment.
What tests should be done at age 40? ›- Body mass index (BMI)/obesity screening. ...
- Depression screening. ...
- Alcohol, smoking and substance misuse screening. ...
- Human immunodeficiency virus (HIV) screening. ...
- Blood pressure check. ...
- Cholesterol screening.
The researchers behind a 2016 study examined the effects of yearly or 2-yearly mammograms on women aged 40–74 years. They note that exposure to repeated mammography can increase the risk of developing breast cancer and that this risk may be higher for those with larger breasts.
Who should get a mammogram at 40? ›The American Cancer Society states women ages 40-44 should have the option to have a mammogram every year [8]. It recommends routine screening mammography starting at age 45 [8]. The National Comprehensive Cancer Network (NCCN) recommends routine screening mammography for women starting at age 40 [9].
What are the new NCCN Guidelines for mammography all women over 40? ›Women age 40 and older at average risk of breast cancer should have a physical exam and a mammogram every year. Women with a higher-than-average risk of breast cancer should have a physical exam every six to 12 months. Screening should start before age 40 and include an annual mammogram or breast MRI.
How often should you get a mammogram at 40? ›Ages 40 to 44: Should consider having a mammogram every year with your decision informed by a shared decision making process with your health care provider. During this process, they will explain the benefits and harms of screening. Ages 45 to 54: Have a mammogram every year.
Should women ages 45 to 54 get a mammogram? ›The American Cancer Society says women ages 45 to 54 should get mammograms every year -– but can choose to start at 40 and then at 55, can choose to switch to every other year.
Should women aged 50 or older get mammograms at least every two years? ›
Breast cancer
Women age 45 to 54 should get mammograms every year. Women 55 and older should switch to mammograms every 2 years, or can continue yearly screening. Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer.
They found that in women aged 70 to 74, the benefit of screening outweighed the risks, which can include overdiagnosis, overtreatment and the anxiety of a potential breast cancer diagnosis. In women 75 to 84, screening did not substantially reduce the risk of dying from breast cancer.
How often should you get a mammogram if you have dense breasts? ›If you have dense breast tissue and are at an increased risk of breast cancer due to a genetic mutation or other factors, your care team may recommend alternating MRIs and mammograms every six months.
Is ultrasound better for dense breasts? ›Extra screening with ultrasound
Any woman who has dense breasts may want to consider supplemental screening, usually with breast ultrasound. Studies show that screening with ultrasound, in addition to mammography, improves detection of breast cancers in women with dense breasts.