Women, Don’t Wait: Task Force Advises Starting Mammograms At 40

The latest data on breast cancer in younger women has prompted the US Preventive Services Task Force (USPSTF) to change its screening guidelines. In its new draft, the task force now says all women – regardless of race, ethnicity, or breast density – should get their first mammogram at 40 then every other year after.

Previously, the task force had recommended women start screenings at 50, with younger women deciding when to start based on individual risk.

“This new recommendation will help save lives and prevent more women from dying due to breast cancer,” says Carol Mangione, past USPSTF chair and internal medicine specialist at the David Geffen School of Medicine, UCLA.

Since 1990, cancer rates in women under 50, including those for breast cancer, have increased, according to a study from Brigham and Women’s Hospital. Dropping the age to 40 to screen more women – and catch more cancers early – could save more lives, as much as 19% the task force says.

The new screening age is also more consistent with the screening guidelines from the American Cancer Society, which recommends women between 40 and 44 “have the option” to start yearly mammograms while women at 45 “should.”

Regular screenings provide the most reliable means of early detection, ACS says, adding that when caught early breast cancer “is easier to treat successfully.”

More Research Needed

Still, as the task forces states in its draft guidelines, more research is needed in key areas, specifically for women with dense breasts and Black women, both of which face a greater risk of getting the disease.

As the task force points out, breast cancer is the second most common cancer and the second most common cause of cancer death for women in the US. However, Black women are 40% more likely to die of the disease than white women and often develop it at younger ages. The task force says more research is needed to understand and correct this disparity.

“What we don’t know yet, and what we are urgently calling for more research on, is whether and how additional screening for women with dense breasts might be helpful.” – John Wong

Women with dense breasts – nearly half of all women – are not only at higher risk, mammograms are not as effective in pinpointing cancer in dense tissue, according to task force member John Wong, a primary care clinician at Tufts Medical Center in Boston.

“What we don’t know yet, and what we are urgently calling for more research on, is whether and how additional screening for women with dense breasts might be helpful, including through ultrasound, breast MRIs, or something else,” Wong says.

In March, the FDA updated its mammography regulations, requiring facilities to inform patients about breast density and recommend those with density to seek further consultation as to whether they should get additional screening. (Also see "News We’re Watching – FDA Mammography Update, SVB Collapse, Zoll's Data Breach, And More" - Medtech Insight, 17 Mar, 2023.)

The task force says more research is also needed to address disparities among Hispanic, Latina, Asian, Native American, and Alaska Native women as well, particularly ensuring they receive equitable follow up appointments after initial screenings.

“Timely and effective treatment for breast cancer has the potential to save more lives for people experiencing disparities related to racism, lack of access to care in rural communities, low income, and other factors,” the task force says.

More study into screening and treatment for women older than 75 is also required, the task force says, as “the balance of benefits and harms may shift as women age, but there is very limited research on this age population.”

Hologic, a medical technology company that specializes in women’s health, agrees with the new guidelines calling them a significant step forward.

“Lowering the age for initial screening to 40 is critical as approximately 60,000 breast cancers are diagnosed each year in women under 50,” the company said in an email to Medtech Insight. “Further, Black women are more likely to develop aggressive cancers at younger ages than white women and are 40% more likely to die from breast cancer than white women.”

The new draft recommendations are open for public comment until 5 June.