U.S. Preventive Services Task Force Report on Screening of Breast Cancer

The revised USPSTF recommendations — which were reviewed by the Academy’s Commission on Health of the Public and Science — call for biennial screening mammography for women ages 50-74 years and state that the decision to start regular, biennial screening mammography before the age of 50 should be an individual one that takes patient context into account, including the patient’s values regarding specific benefits and harms.

“It enables family physicians in particular to know the patient, know their history and help patients make decisions for themselves guided by a thoughtful discussion.”

The U.S. Preventive Services Task Force, or USPSTF, recently released new recommendations for the screening of breast cancer. These new recommendations have generated a large amount of criticism and concern among women, physicians, and other research groups. What exactly is so controversial about these recommendations and what do they mean for you? Let’s first take a closer look at the recommendations themselves.

Summary of Recommendations:

1. The USPSTF recommends screening mammography for women aged 50 to 74 years every other year.
2. The decision to start regular, biennial screening mammography before the age of 50 years should be an
individual one and take patient context into account, including the patient’s values regarding specific
benefits and harms.
3. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and
harms of screening mammography in women 75 years or older.
4. The USPSTF recommends against teaching breast self-examination (BSE).
5. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and
harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older.
6. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and
harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as
screening modalities for breast cancer.

The first two recommendations represent a significant shift from the recommendations issued in 2002 and are where most of the controversy is centered. Previously, the USPSTF recommended screening mammography, with or without clinical breast examination, every one to two years for women ages 40 and older. The new recommendations also differ from what is currently recommended by the American Cancer Society, American College of Obstetricians and Gynecologists, American College of Radiology (ACR), and the Society of Breast Imaging (SBI) who all recommend annual screening mammography starting at age 40 for most women, and even earlier in those with high risk. So, what does this mean if you are a woman in your 40s or over 75? The decision about whether mammography is right for you should be based on your family history, general health, and personal values. There are risks associated with screening mammography such as over treatment and exposing the breast to radiation, so careful consideration of what is right for you is warranted. Perhaps, the only thing that the recommendations and the controversy surrounding them make clear is that there is a need for further research in breast cancer prevention. We at Kernersville Primary Care encourage you to discuss the risks and benefits of screening mammography with your doctor and decide what measures are best for you.