On January 11, the U.S. Preventive Services Task Force (USPSTF) released its latest recommendations for screening mammograms. It recommended a biennial (every other year) screening mammography for women aged 50 to 74 years. For woman below the age of 50, the decision to start screening mammography in women should be an individual one. Women who place a higher value on the potential benefit than the potential harms may opt to begin biennial screening between the ages of 40 and 49 years.
For women who are at average risk for breast cancer, most of the benefit of mammography results from biennial screening during ages 50 to 74 years. Of all of the age groups, women aged 60 to 69 years are most likely to avoid breast cancer death via mammography screening. Screening mammography in women aged 40 to 49 years may reduce the risk for breast cancer death; however, the number of deaths prevented is smaller than that in older women; in addition, the number of false-positive results and unnecessary biopsies is larger. The balance of benefits and harms is likely to improve as women move from their early to late 40s.
In addition to false-positive results and unnecessary biopsies, all women undergoing regular screening mammography are at risk for the diagnosis and treatment of noninvasive and invasive breast cancer that would otherwise not have become a threat to their health, or even apparent, during their lifetime. This is known as “overdiagnosis”. Beginning mammography screening at a younger age and screening more frequently may increase the risk for overdiagnosis and subsequent overtreatment.
Women with a parent, sibling, or child with breast cancer are at higher risk for breast cancer; therefore, they may benefit more than average-risk women from beginning screening in their 40s. The USPSTF concludes that the current evidence is insufficient to evaluate the balance of benefits and harms of screening mammography in women aged 75 years or older. In addition, the USPSTF concludes that the current evidence is insufficient to assess the benefits and harms of digital breast tomosynthesis (DBT) as a primary screening method for breast cancer. In addition, the USPSTF concludes that the current evidence is insufficient to evaluate the balance of benefits and harms of adjunctive (supplementary) screening for breast cancer using breast ultrasonography, magnetic resonance imaging, DBT, or other methods in women identified to have dense breasts on an otherwise negative screening mammogram.