Breast Imaging

USPSTF’s Mammography Letdown?

Last year’s relief that the USPSTF would lower its recommended starting age for breast screening to 40 gave way to frustration this week that the group did not go farther in its final decision on mammography recommendations. 

In a series of papers in JAMA journals this week, the USPSTF tackled a range of breast screening issues, from the age at which screening should start to whether modalities like ultrasound and MRI should be used to supplement conventional mammography.

That was the good news. The bad news is that breast screening advocates mostly got shut out on a variety of other issues, with the USPSTF … 

  • Advising that breast screening be conducted biennially (every two years), rather than annually as most women’s imaging advocates would prefer
  • Declining to raise the recommended upper limit for screening from 74 to 79
  • Declining to recommend supplemental screening with MRI or ultrasound for women with dense breast tissue, even as women express frustration with the lack of reimbursement for these exams

On the positive side, the USPSTF finally weighed in on DBT, stating that the 3D mammography technology is equivalent to digital mammography for breast screening. 

  • But in another disappointment, the group said it couldn’t find any studies stating that DBT was better than 2D digital mammography. 

Given the fierce battles that have been fought over screening guidelines in the last 15 years, what made the USPSTF change its mind on mammography’s starting age? 

  • One big factor is the 2% annual rise in breast cancer incidence in women in their 40s from 2015 to 2019; the higher mortality rates among Black women was another issue (see story below in The Wire).

The Takeaway

The USPSTF’s move to lower its recommended starting age for screening mammography is a welcome – if overdue – change for women, who for 15 years have borne the brunt of the group’s conservative approach to guideline formation. The question remains, is the USPSTF making the same mistake all over again when it comes to supplemental imaging and annual screening? And how long will women have to wait this time until it sees the light?

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