The U.S. Preventive Services Task Force plans to recommend that breast cancer screening start at age 40 to benefit groups including Black women and women with dense breasts.
, a radiologist at Massachusetts General Hospital, was highly critical of the task force’s decision to recommend mammograms every other year considering that Black women and Jewish women die from breast cancer prior to age 50 — or even 40 — more often than white women as a whole. “That’s just going to exacerbate the racial disparities,” she warned.
“Their own evidence shows that the most lives are saved with yearly screening,” said Monticiollo, who led the drafting of the American College of Radiology/Society of Breast Imaging recommendations. “With annual screening of women 40-to-79, you get a 42% mortality reduction. Limit that to every other year, and it drops the mortality reduction to 30%. These are women’s lives that would be saved. I don’t know what their thinking is here.
The task force noted other consequences of shifting from the least-intensive to the most-intensive screening schedule, however. The number of mammograms a typical woman received tripled, as did the number of false positive readings. The rate of overdiagnosis more than doubled, from 8% of cases to 17%.
“Even many experts can’t come to grips with how many cancers are caused by mammogram screening and how many deaths are diverted by that screening,” said Brawley. People who carry genes that predispose them to some cancers may be particularly vulnerable to radiation-induced mutations, he said. “But that’s not a trade-off that’s been explored with strong research,” he added.
The task force made clear that its new recommendations were not undergirded with rock-solid confidence. That women should begin getting mammograms at 40 had its most solid research backing. But the task force assigned far lower confidence values to its every-other-year schedule of mammography, and to the idea that breast-cancer detection after 75 may not be life-saving.The draft recommendation will be open for public comment until June 5.
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