PHILADELPHIA — November 16, 2009 — In an update to its 2002 recommendations, the US Preventive Services Task Force (USPSTF) now recommends against routine breast cancer screening for women under the age of 50. Women between the ages of 40 and 49 at high risk for breast cancer should talk to their doctor about the best time to start regular, biennial screening mammography.These recommendations appear in the November 17 issue of Annals of Internal Medicine. The full recommendation is available online at www.annals.org.
In addition to revising the age at which mammography screening should begin, the USPSTF also suggests changing the screening interval from 1 year to 2, up to the age of 74. There is insufficient evidence to determine the screening benefits and harms for women aged 75 or older.
The Task Force recommends against teaching breast self-examination, as adequate evidence suggests that teaching self-examination does not reduce breast cancer mortality. USPSTF researchers also conclude that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination for women 40 and over. This recommendation is a change from the 2002 statement, which suggested mammography screening, with or without clinical breast examination, every 1 to 2 years for women aged 40 years or older.
According to the available evidence, screening with film mammography reduces breast cancer mortality, especially for women aged 50 to 74 years, with the greatest benefit seen in women aged 60 to 69. Among women 75 and older, evidence of the benefits of mammography is lacking.
In response to the USPSTF recommendations, Otis W. Brawley, MD, Chief Medical Officer, American Cancer Society (ACS), said, “As someone who has long been a critic of those overstating the benefits of screening, I use these words advisedly: this is one screening test I recommend unequivocally, and would recommend to any woman 40 and over, be she a patient, a stranger, or a family member.”
In 2003, the ACS convened an expert panel to review the data available at the time, which, Dr. Brawley said, “was not substantially different from the data included in the current USPSTF review.” At that time, the ACS panel found “convincing evidence that screening with mammography reduces breast cancer mortality in women ages 40-74, with age-specific benefits varying depending on the results of individual trials and which trials were combined in meta-analyses,” said Dr. Brawley. “We specifically noted that the overall effectiveness of mammography increases with increasing age. But the limitations do not change the fact that breast cancer screening using mammography starting at age 40 saves lives.”
The USPSTF did not recommend one form of mammography over another. According to its recommendation, the current evidence is insufficient to assess additional benefits and harms of either digital mammography or magnetic resonance imaging instead of film mammography as screening modalities for breast cancer.
To update the 2002 recommendation statement, researchers systematically reviewed published evidence of the efficacy of 5 screening modalities in reducing mortality from breast cancer: film mammography, clinical breast examination, breast self-examination, digital mammography, and magnetic resonance imaging. In addition, the Task Force commissioned 2 studies related to breast cancer screening: a targeted systematic evidence review of 6 selected questions relating to the benefits and harms of screening; and a decision analysis that used population modeling techniques to compare the expected health outcomes and resource requirements of starting and ending mammography screening at different ages and using annual versus biennial screening intervals.
For more details on the breast cancer screening guidelines from the USPSTF,click here.
SOURCE: American College of Physicians, American Cancer Society