Speak Now About USPSTF Breast Cancer Screening Recommendations

April 21, 2015

USPSTF released a draft recommendation statement on breast cancer screening; little has changed since the last statement in 2009.

The United States Preventive Services Task Force (USPSTF) posted their draft recommendation regarding breast cancer screening and is asking for public comment until May 18, 2015 at 8:00 PM EST.

Despite pressure from breast cancer screening proponents who want the recommendations to include annual mammography screening for women starting at age 40, the USPSTF guidelines largely mirror the 2009 recommendations of biennial screening for women ages 50-74.

The recommendations state that there is “adequate evidence that mammography screening reduces breast cancer mortality in women ages 40-74 years.” Women ages 40-49 benefit the least from mammography screening, and women ages 60-69 benefit the most, according to the rationale. The USPSTF also cited “adequate evidence that screening for breast cancer for mammography results in harms for women ages 50-74 years.” The most important harm, according to the rationale, is the “diagnosis and treatment of noninvasive and invasive breast cancer that would otherwise not have become a threat to a woman’s health, or even apparent, during her lifetime (i.e., overdiagnosis and overtreatment.” The rationale cited psychological harms and unnecessary invasive testing that accompany overdiagnosis and overtreatment.

The USPSTF was unable to come to a conclusion about the balance of  benefits and harms of tomosynthesis as a primary screening modality for breast cancer. They similarly cited no adequate evidence for benefits and harms of adjunctive screening for breast cancer using ultrasound, MRI, tomosynthesis, or other modalities in women identified to have dense breasts or a negative screening mammogram.

“While there is some information about the accuracy of these modalities, there is no information on the effects of their use on health outcomes, such as breast cancer incidence, mortality, or overdiagnosis rates,” the recommendation states.

This is only a draft of the recommendations. Public input will be accepted until May 18, 2015 at 8:00 PM EST. A final recommendation will be developed after careful consideration of the feedback received, according to the USPSTF. Make sure to voice your concerns during this period. Read the full recommendation here.

Summary of the Guidelines:

GroupRecommendationGrade
Women ages 50–74Biennial screening mammographyB; Offer or provide this service
Women ages 40–49Decision to start screening mammography should be an individual oneC; Offer or provide this service for selected patients depending on individual circumstances
Women age 75 and olderEvidence is insufficient to assess balance of benefits and harms of screening mammographyI; patients should understand the uncertainty about the benefits and harms if service is offered
All womenInsufficient evidence to assess the benefits and harms of tomosynthesis as a screening modality for breast cancerI; patients should understand the uncertainty about the benefits and harms if service is offered
Women with dense breastsInsufficient evidence to assess the balance of benefits and harms of adjunctive screening for breast cancer using ultrasound, MRI, tomosynthesis, or other modalitiesI; patients should understand the uncertainty about the benefits and harms if service is offered