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New Recommendations on Screening for Breast Cancer

Mammography most beneficial for women aged 50 to 74

The U.S. Preventive Services Task Force, an independent, volunteer panel of experts in preventive care and evidence-based medicine, has reviewed the scientific data about the benefits and harms associated with breast cancer screening, and has posted a draft recommendation statement based on that evidence. The statement consists of several recommendations, addressing different age groups and screening methods.

Based on the evidence, the task force found that the benefit of mammography screening increases with age, with women aged 50 to 74 years benefiting most. The task force also concluded that women receive the best balance of benefits to harms when screening is performed every 2 years.

For women in their 40s, the task force found that mammography screening every 2 years can also be effective and recommends that the decision to start screening should be an individual one, recognizing the potential benefits as well as the potential harms. The science shows that some women in their 40s will benefit from mammography but that most will not, while others will be harmed, the experts say.

Of the potential harms, the most serious is unneeded diagnosis and treatment for a type of breast cancer that would not have become a threat to a woman’s health during her lifetime. The most common harm is a false-positive test result, which often leads to additional tests and procedures.

Among women in their 40s, those who have a mother, sister, or daughter with breast cancer may benefit more than average-risk women by beginning screening before age 50.

 “Women deserve to be empowered with the scientific data about the benefits and harms of mammography so they can make informed choices about their health,” says task force Vice-Chair Kirsten Bibbins-Domingo, PhD, MD. “Supported by the science, every woman should use her own values, preferences, and health history to make the decision that is right for her.”

The task force has developed several additional recommendations as part of its draft recommendation statement:

•     For women aged 75 and older, the task force determined that the current evidence is insufficient to make a recommendation for or against mammography screening.

•     While 3-D mammography is a promising new technology for the detection of breast cancer, the task force did not find enough evidence to determine whether it will result in better overall health outcomes for women. Therefore, the task force cannot make a recommendation for or against the use of 3-D mammography.

•     Certain factors increase a woman’s risk for developing breast cancer. Women who have dense breasts are at an increased risk, and high breast density also reduces the ability of mammography to find and accurately identify breast cancer, the task force finds. However, the evidence on how additional screening beyond mammography may or may not help women with dense breasts is unclear. Therefore, the task force cannot make a recommendation for or against such additional screening.

“Mammography is an important tool in reducing the number of breast cancer deaths. Based on the evidence, the task force found that screening is most beneficial for women ages 50 to 74,” said the task force’s immediate past chair, Michael L. LeFevre, MD, MSPH. “The evidence shows that screening women age 40 to 49 is beneficial as well, but fewer women will avoid a breast cancer death by screening at this age. The number of women who experience a false–positive result and unnecessary testing is actually higher. Women who place a higher value on the potential benefit than the potential harms may choose to begin screening between the ages of 40 and 49.”

Source: USPSTF Bulletin; April 21, 2015.

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