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According to new recommendations from the US Preventive Services Task Force, women are recommended to get a mammogram every two years starting at age 40 and continuing until age 74.
of USPSTFA volunteer group working to guide doctors' decisions and influence insurance plans previously recommended that the decision to start biannual mammograms at age 50 and screen women in their 40s “should be an individual one.”
These brand new RecommendationsPublished Tuesday in the medical journal JAMA, replace the task force 2016 recommendations. Some groups like the American Cancer Society have It is already recommended that women start mammograms in their 40s.
The updated USPSTF recommendations apply to everyone assigned at birth, including women, transgender men and non-binary people, as well as those with a family history of breast cancer or dense breasts.
The revised recommendations do not apply to people with individual breast cancer, a genetic marker or syndrome, such as the BRCA1 or BRCA2 genes, or people with high rates of breast cancer. Radiation therapy to the chest or a history of high-risk breast lesions. These patients should stay on the plan prescribed by their doctor or discuss with their doctor what is best for them.
“The new science clearly shows that getting mammograms starting at age 40 and every year until age 74 can reduce breast cancer mortality,” he said. USPSTF Chairman Dr. Wanda Nicholson, senior associate dean and professor at George Washington University Dairy Institute School of Public Health.
The benefit of breast cancer screening is that it helps detect cases before the cancer spreads, which reduces the chance of dying from the disease.
It's breast cancer. The second most common cancer in women In the United States, it is the second leading cause of cancer death after skin cancer and lung cancer.
“With this improved strategy – we could save up to 20% more lives,” Nicholson said of the new recommendations.
According to the American Cancer Society and mammography – by taking a breast X-ray – 1 in 8 women will develop invasive breast cancer in their lifetime. It remains the best tool to diagnose and diagnose the disease.
The USPSTF has received some criticism for recommending screening annually rather than annually.
Using USPSF terminology, annual screening is just as 'effective' as biennial screening, but results in overall reductions in late-stage disease and breast cancer deaths and significant gains in years of life saved, said Dr. Wendy Berg of the University of Pittsburgh School of Medicine. He wrote in an editorial published on Tuesday in the journal JAMA Oncology. She added, “It's surprising that the USPSTF recommends biennial screening instead of annual screening.”
“The updated USPSTF recommendations are an important step forward, but they stop short. Annual mammography is as effective as biennial mammography but has a greater overall gain in life years saved,” Berg wrote. It's important for women in minority groups.”
Along with recommending screening every two years, there are other concerns about how the USPSTF makes blanket recommendations for the average risk population as well. Those who have a family history of breast cancer or have dense breasts, says Molly Guthrie, vice president of policy and advocacy at the Susan G. Komen Breast Cancer Foundation.
About half of women over 40 in the United States have dense breast tissue. According to the US Food and Drug AdministrationThis was last year Updated mammography rules All US screening facilities must inform patients of their breast density with their mammography results.
“We were very surprised to see how they opened up the intended audience and it doesn't show the level of identifying people who are at high risk for breast cancer today,” Guthrie said. “I'm afraid this will further muddy the waters on what people are expected to do.
Some experts recommend that people with a direct family history of breast cancer or Thick breasts Both factors are associated with increased risk of breast cancer and should have different screening recommendations. That's why, Guthrie said, it's a good idea for women to talk with their doctors about their own personal medical and family history and what's best for them.
“There's been a lot of focus on these systems designed to assess people's risk, and when you discuss that with your provider, you can determine your risk and the type and frequency of breast imaging you need. ” said Guthrie.
“The good and bad thing about the task force guidelines is that they are tied directly to health plans and they have to cover it at no cost,” she said. And by not recommending annual screening, “we are concerned that the updated recommendation will reduce screening access and uptake, which means we will likely see a late-stage diagnosis, and that is when breast cancer is the most difficult for the overall health care system to treat and the most expensive.”
Nicholson said USPSTF members found no evidence to support annual screening in their review of published research and data.
“There are currently no randomized trials comparing annual screening with annual screening. However, as part of our systematic evidence review, which is part of all of our recommendations, we found evidence that annual screening does not increase late-stage breast cancer screening when compared annually. ” said Nicholson.
“When we look at our modeling studies to assess the balance of benefits and harms, there is a more favorable balance of benefits and harms compared to annual screening,” she says. “You had a 50% higher rate of false positives at the annual screening.”
False-positive results for breast cancer mean that a mammogram may be found to be abnormal when cancer is not present. This can lead to patients needing more biopsies, repeated tests and lasting psychological distress.
“Getting screened annually maximizes the benefits of screening and reduces the associated harms. These harms can include being told you have cancer when you don't have it — or when you're told you don't and receiving unnecessary treatment.” Patient fact sheet from the USPSTF.
The USPSTF's shift from saying women should make individual screening decisions in their 40s to women starting screening at age 40 seems more in line with what some other organizations have recommended for some time.
The American Cancer Society recommends that women ages 40 to 44 have the option of getting a mammogram every year, that women ages 45 to 55 get a mammogram every year, and that women 55 and older can switch to a mammogram every year.
“The USPSTF decision is a significant change in women's health and the fight against breast cancer today. It sends a strong message to doctors and women that women in their 40s should benefit from mammography screening and that breast cancer screening should begin earlier than age 50,” said Dr. Karen Knudsen. , CEO of the American Cancer Society, said in part in the statement.
“Mammography screening is the cornerstone of our strategy to make this deadly disease easier to treat,” Knudsen added. “However, we are disappointed that the updated USPSTF screening recommendations do not include women over age 74. Millions of women over age 75 are in excellent health and are expected to live many more years at increased risk of developing breast cancer.” He said.
of The American College of Obstetricians and Gynecologists recommends They say women who are at risk for breast cancer every year, on average, starting at age 40, should get screened every year for up to two years starting after age 50.
Advantages and disadvantages of screening
Task force members analyzed data from seven randomized clinical trials and 13 nonrandomized studies, as well as a new modeling study, to help inform the updated screening recommendations.
“We were able to look at the balance of benefits and harms in terms of screening time and age,” Nicholson said.
Members of the USPSTF found that breast cancer screening every two years for women ages 40 to 74 can reduce the risk of dying from breast cancer. But the evidence was insufficient to determine the balance of benefits and harms for screening women 75 and older. The task force also said the evidence was insufficient to assess the benefits and harms of increased screening in women with dense breasts.
The revised recommendation includes both traditional digital mammography and digital breast tomosynthesis, or “3D mammography,” as effective screening approaches.
The USPSTF reviews its recommendations every five years to update or confirm them, Nicholson said, and the task force “consistently” seeks new evidence to inform any updates.
For the new recommendations, the USPSTF found “clear evidence” that the incidence of invasive breast cancer among 40- to 49-year-olds is increasing by about 2% annually, Nicholson said.
“More and more women in their 40s are being diagnosed with invasive breast cancer,” she said. “For the first time, we also have data on black women, and we know that black women are about 40% more likely to die from breast cancer compared to white women. So this was an important and up-to-date follow-up data that we had that provided input for our collaborative modeling studies.”
The revised USPSTF recommendations state that there are “defined inequities” in breast cancer, and that black women are at higher rates compared to white women and are generally less likely to be diagnosed with the disease, but are more likely to die.
The task force called for “robust research” to better understand and identify ways to address these inequities.
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