Industry Experts Applaud Changes Behind USPSTF Breast Screening Guidelines Update

January 27, 2021
Whitney J. Palmer

A focus on more comprehensive, up-to-date research and inclusion of racial disparities data will lead to more appropriate mammography screening guidelines, experts say.

Last week, the U.S. Preventive Services Task Force (USPSTF) publicized its plans for how it would create the next iteration of mammography screening guidance. The moves are designed to address long-standing concerns within the industry – and, this time, providers within the community are praising the efforts.

When USPSTF last released mammography screening guidance in 2016, the group was criticized for holding on to a hotly debated 2009 recommendation that biannual screening was enough for women in their 50s even when many in the industry advocate for annual screening for women beginning at age 40. But, the decision was also controversial because it was based on data culled from existing mammography randomized controlled trials (RCTs) that were considered outdated.

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With this next round of screening guidelines, the Task Force has signaled it will modernize its decision-making process. It will still rely on RCTs, but it is casting a wider net, including cohort studies with contemporaneous controls, population-based nested case-control studies, as well as cross-section studies large population-based studies or included trials.

Successfully making this change could be critical because many payers use these guidelines to direct their reimbursement decisions for screening mammography. Consequently, these moves could make screening mammography more affordable and more widely accessible.

According to Christoph Lee, M.D., MS, MBA, professor of radiology and director of the Northwest Screening and Cancer Outcomes Research Enterprise at the University of Washington, these moves will greatly strengthen the forthcoming guidelines.

“I think the USPSTF is doing the right thing by including both randomized trial data and large observational study data to inform their breast cancer screening recommendations,” he told Diagnostic Imaging. “Almost all of the mammography randomized controlled trials are based on outdated technologies and more follow-up data from those trials are of limited value. Meaningful effectiveness data on newer screening modalities are largely observational in nature.”

The USPSTF is also shifting to concentrate more on the racial disparities that exist in breast cancer screening and outcome. In specific, the group's proposal asked about structural racism, social inequalities, and unequal access-to-care, as well as what factors might contribute to disparities in breast cancer screening and care and what might play a role in the higher breast cancer mortality rate among African American women.

Lee praised this move, as well, calling it a step in the right direction for providing more equitable care nationwide.

“It’s encouraging that the USPSTF is considering tailored screening approaches based on risk factors other than age, including race and ethnicity,” he said. “By including measures of structural racism and quality-of-care in their research framework, we may be seeing a more meaningful movement towards health equity in breast cancer screening access and outcomes.”

In addition, the USPSTF will also examine risk assessment tools for average-risk screening populations, personal screening preferences by age group, the accuracy and reproducibility of BI-RADS breast density determinations, and how mammography effectiveness trials impact beliefs around the pros and cons of screening.

Given the influence these guidelines can yield, said Amy Patel, M.D., assistant professor of radiology at the University of Missouri at Kansas City and medical director of the Women’s Imaging Center at Liberty Hospital, the USPSTF has made the right decision, noting that these moves correct the short-coming of relying on old data captured by using older technology.

“We do think they are on the right track,” she told Diagnostic Imaging. “Our hope is the focus on more recent trials, as well as broadening research scope, including race and effectiveness-of-screening, on advanced cancer diagnosis, will demonstrate what we already know to be true and what is currently recommended by expert sub-specialty groups like the Society of Breast Imaging and American Society of Breast Surgeons.”

The public comment period for the new USPSTF plan is open until Feb. 17. After the research plan is finalized, investigators will systematically review evidence to answer the questions laid out in the final research plan before releasing new draft recommendations and evidence review. Another public comment period will follow before the final recommendations are released.

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