Alarmed by rising breast cancer diagnoses among young women and persistently high mortality rates, especially among black women, health experts propose a major revision to standard medical advice about mammograms on Tuesday. bottom.
According to the U.S. Preventive Services Task Force, women of all racial and ethnic backgrounds with average breast cancer risk should start regular breast cancer therapy at age 40, rather than waiting until age 50 as previously recommended. You should start getting mammograms at
This group publishes influential guidelines on preventive health, and its recommendations are typically widely adopted in the United States. But the new advice issued as a draft represents something of a reversal.
In 2009, the USPSTF increased the starting age for routine mammograms from 40 to 50. Negative.
In recent years, however, breast cancer has seen a troubling trend. This includes a clear increase in the number of cancers diagnosed in women under the age of 50 and survival rates for young black women who die of breast cancer twice as often as white women of the same age. This includes not closing the gap between
“We don’t really know why breast cancer has increased among women in their 40s,” Dr. Carol Mangione, the task force’s immediate past chairman, said in an interview. The more people in a stratum have the disease, the more effective screening will be for that group.”
The new recommendations target more than 20 million women between the ages of 40 and 49 in the United States. In 2019, About 60% of women in this age group 76% of women aged 50 to 64 and 78% of women aged 65 to 74 said they had had a mammogram in the past 2 years.
The panel said there was insufficient evidence to make any recommendations for women over the age of 75.
Dr. Mangione said the USPSTF has commissioned the first study of breast cancer in all women, not just black women, and said more research is needed on what drives racial disparities. The task force is also calling for clinical trials to compare the effectiveness of annual and biennial screening in black women.
Overall, mortality from breast cancer has declined in recent years. Still, it is the second most common cancer among women in the United States, after skin cancer, and after lung cancer, it is the second leading cause of cancer death.
From 2000 to 2015, breast cancer diagnosis rates among women in their 40s increased by less than 1%, but from 2015 to 2019, the rate increased by an average of 2% per year, the task said. Force points out.
The reason is not entirely clear. Delayed births, or not having children at all, may be driving this increase, said Rebecca Siegel, senior scientific director of surveillance research at the American Cancer Society. Having a baby before age 35 reduces the risk of breast cancer, as does breastfeeding.
Still, she noted that there is wide variation in diagnosis rates from year to year.The increase in young women may simply reflect increased screening, according to Dr. Stephen Wolthin, a professor of medicine at Dartmouth College. Some researchers suggest that there is
Researchers have found that frequent screening itself can be harmful, leading to unnecessary biopsies that cause anxiety and treatment for non-life-threatening, slow-growing cancers.
But in 2009, a storm of criticism erupted from both patients and advocacy groups when the task force advised only women over the age of 50 to have regular mammograms. Critics of that guidance suggested that fears of missing malignancies among young women and a desire to cut medical costs drove the recommendations.
At the time, the committee also called for longer intervals between mammograms. Not a yearly scan, he’s once every two years. That recommendation still stands.
The American Cancer Society differs in this important respect. The association says women aged 40 to 44 should be able to opt for screening. Women should have annual mammograms starting at age 45 Until age 55, when the risk of breast cancer begins to decline.
ACS chief executive Karen E. Knudsen welcomed the task force’s advice to begin regular screening at a younger age to reduce confusion arising from conflicting recommendations from medical groups. said.
Still, she said: Cancer in premenopausal women grows rapidly, so it is important that it does not occur and go undetected for two years. “
The Task Force’s new recommendations apply to all people assigned to women at birth who are asymptomatic and at average breast cancer risk. This includes those with dense breast tissue and a family history of breast cancer.
However, this advice is not recommended for people who already have breast cancer, who have a genetic mutation that increases their risk, who had breast lesions identified on a previous biopsy, or who received high doses of radiation to the chest and never had cancer. It does not apply to people at increased risk of
These women should talk to their doctor about how often they should be screened.
The task force emphasized the importance of black women starting mammograms at age 40. This is because black women are more likely to get advanced tumors at a younger age and are 40% more likely to die from breast cancer than white women.
Some scientists want to move away from a universal, one-size-fits-all approach to screening. In favor of a “risk-adapted” approachThis means screening black women six to eight years earlier than white women.
Dr. Mahdi Farah, who studies risk-adapted cancer prevention at the German Cancer Research Center in Heidelberg, said: .
However, screening alone is unlikely to improve survival for black women who are not only more likely to develop aggressive tumors, but who suffer from delayed access to medical care or living conditions that make treatment difficult. you can’t.
Follow-up for abnormal breast scans, for example, is often delayed, especially for black women, according to a new task force report.
“With black women, we often hear stories they don’t want us to hear,” Dr. Mangione said.
“Often, these are women who found a lump themselves or who knew their discharge was abnormal and were hospitalized and fired. simply because they don’t want to accept no for an answer.”
