A new study on mammography screening confirms the worst fears of women’s health advocates: screening rates fell for women ages 40-49 after the USPSTF in 2009 withdrew its recommendation that younger women get biennial screening.
Breast screening has long been the most controversial cancer screening exam, with screening’s opponents claiming that its “harms” – such as breast biopsies and overdiagnosis – don’t justify its benefits.
- The anti-mammography wave crested in 2009 when the USPSTF withdrew its screening recommendation for women ages 40-49 and older than 75, instead advising them to consult with their physicians.
The change prompted confusion and anger that persisted until the task force in 2024 rescinded the 2009 guidance and returned to a broad recommendation in favor of biennial screening for women in their 40s (screening still isn’t recommended for women over 74).
- This left the breast imaging community pondering the impact that 15 years of the more restrictive guidance had on breast screening rates.
Researchers address that question in a new study in JAMA Network Open, in which they analyzed screening records for 1.6M women, finding the probability of getting a biennial mammogram …
- Fell -1.1 percentage points for all women ages 40-49.
- Fell -3 percentage points for non-Hispanic Black women 40-49, the biggest decline among younger women.
- Fell -4.8 percentage points for all women 75 years and older.
- Fell -6.2 percentage points for Hispanic women over age 75, the biggest decline among all age groups.
The new research confirms other studies finding that the USPSTF 2009 guidance led to a small – but statistically significant – decline in overall breast screening rates.
- What’s new is its discovery of demographic variations in the magnitude of the change, an important finding given recent studies showing that Black women have a 39% higher breast cancer mortality rate.
In fact, rising cancer risk in Black women was cited by the USPSTF as one of its reasons for changing its guidance in 2024.
- The USPSTF estimated that lowering screening’s starting age to 40 would avert 1.8 additional deaths per 1k Black women screened every two years
The Takeaway
Hopefully, we’ve seen the end of the “mammography wars” that led to the USPSTF’s 2009 guideline change. A better future is one in which breast screening decisions are made with consideration for factors like cancer risk in addition to just age.
