First Mammogram At 40

 

Breast cancer is the most common cause of cancer in women in the United States (excluding skin cancer) and the second-leading cause of cancer death in women after lung cancer. The American Cancer Society estimates that in 2023, nearly 300,000 new cases of invasive breast cancer and more than 55,000 with early-stage ductal carcinoma in situ will be diagnosed in the U.S. Although mortality from breast cancer has dropped steadily over the last several decades due to early screening and better treatments, the ACS still expects about 43,700 will die from the disease in 2023. Despite the reduction in mortality, the incidence of breast cancer in the U.S. has actually been rising about 0.5% every year.

Earlier this month, the U.S. Preventive Services Task Force (an independent government agency) issued new and critically important draft recommendations for breast cancer screening. The USPSTF now recommends that all women should be screened for breast cancer with mammography every other year beginning at age 40. 

Previous guidelines recommended annual mammograms from 45-54 years of age, with earlier screening advised for women at high risk of developing breast cancer. For women 55 and older, mammography had been recommended every 1-2 years. The new advice — less frequent screening (every other year instead of annually) beginning earlier (40 years old) — is evidence-based. The Task Force estimates that the change could reduce mortality by nearly 20%, saving an additional 8,000 lives from breast cancer every year:

“New and more inclusive science about breast cancer in people younger than 50 has enabled us to expand our prior recommendation and encourage all women to get screened every other year starting at age 40,” says Task Force immediate past chair Carol Mangione, M.D., M.S.P.H. “This new recommendation will help save lives and prevent more women from dying due to breast cancer.”

 

The USPSTF notes that roughly half of all women are told by their doctors that they have dense breasts, a trait that increases the risk of developing breast cancer. The Task Force was unable to definitively say that more frequent screening with MRI or ultrasound would be beneficial:

“We know that women with dense breasts are at higher risk of breast cancer and, unfortunately, mammograms do not work as well for them,” says Task Force member John Wong, M.D. “What we don’t know yet, and what we are urgently calling for more research on, is whether and how additional screening for women with dense breasts might be helpful, including through ultrasound, breast MRIs, or something else.”

 

The USPSTF describes who has an “average risk” of developing breast cancer, and whose risk is higher:

This draft recommendation applies to women at average risk of breast cancer. This includes people with a family history of breast cancer and people who have other risk factors, such as having dense breasts. It does not apply to people who have a personal history of breast cancer, who are at very high risk of breast cancer due to certain genetic markers or a history of high-dose radiation therapy to their chest at a young age, or who have had a high-risk lesion on previous biopsies. Anyone concerned with their breast health should talk with their healthcare professional.

 

The draft recommendations also address racial disparities to ensure that screening and followup are equitable:

Black women are 40 percent more likely to die from breast cancer than White women and too often get aggressive cancers at young ages. Ensuring Black women start screening at 40 is an important first step, yet it is not enough to improve these inequities. It’s important that healthcare professionals involve patients in a conversation on how best to support them to ensure equitable follow-up after screening and timely and effective treatment of breast cancer.

We are urgently calling for more evidence to better understand whether Black women could potentially be helped by different screening strategies.

 

Read more about breast cancer from the CDC here and the American Cancer Society here.

 

source https://www.thepediablog.com/2023/05/23/first-mammogram-at-40/