Regular screening is important for detecting breast cancer. But exactly how early and how often to get tested isn’t so easy. Medical instruction can seem surprisingly inconsistent. For example, some agencies recommend annual testing starting at age 40, while others recommend waiting until age 50. There is no “generalizable” age that applies to everyone, says Vivian Bee, chief of the Department of Breast Surgery and Oncology at New York University. – Presbyterian Brooklyn Methodist Hospital.
“I think we need a more personalized approach to determining when we should actually start screening, rather than this bucketed starting age,” Bee said. “Obviously people are gone.”
Not only has the incidence of breast cancer increased over the past decade, but the age at which breast cancer is diagnosed has also decreased. And now, several medical regulatory boards and groups are arguing that turning 40 is the time to get regular mammograms. Last month, the United States Preventive Services Task Force (USPSTF), an independent group of clinicians and researchers, suggested that people between the ages of 40 and 74 get mammograms every two years. This is an update from previous guidelines that recommended starting at age 50 and left it up to the government. *These recommendations apply to people assigned female at birth, including cisgender women, transgender men, and nonbinary people. Task Force members also noted data showing disproportionate rates of late-stage breast cancer diagnosis and mortality among people from certain racial and ethnic communities, particularly black women.
“We have new, more comprehensive evidence that biennial breast cancer screenings from age 40 save lives,” said Tufts Medical Center, a member of the task force that helped draft the proposal. says John Wong, a primary care clinician at “It will further help black women and reduce some of the health inequalities.”
Why is age important in mammography?
In general, breast cancer becomes more likely to occur with age. This is because the risk of genetic mutation increases and the mutation becomes more difficult to repair. Natural changes in hormones may also play a role. “Breast cancer is more likely to occur the older you get, but many people get it in their 40s and younger,” says Laurie Margolyes, a radiologist and director of breast imaging at Mount Sinai Hospital. New York City’s healthcare system.
For the proposal, the USPSTF applies newer, more comprehensive data to a comparative model showing survival outcomes for average-risk 40-year-olds with and without breast cancer screening in the United States. bottom. “What we would say is more comprehensive is that these data contain more racial and ethnic groups than the first randomized controlled trials for breast cancer screening conducted almost 20 years ago. It’s because it includes a diverse group of people,” Wong said. The data showed that more women in their 40s are developing breast cancer than ever before.
Long-term data from the National Cancer Institute show breast cancer rates among women under 50 increased by 0.3% per year from 1994 to 2016, compared with 2.7% per year from 2016 to 2019. shown to have increased. Getting tested is an important step in improving your symptoms. Survival and avoidance of invasive treatments are key, says Margolyes. “If the cancer is detected by screening, you are less likely to need a mastectomy, less likely to need chemotherapy, and possibly even having to remove all the lymph nodes in your armpit. lower,” she added. “So it’s very important.”
Many medical institutions are already instructing doctors to screen for breast cancer before age 50. The American College of Radiology recommends mammography screening for average-risk women from age 40. The American Cancer Society says women between the ages of 40 and 44 should be given the option to have a mammogram, and screening should begin for all women by age 45. [screening around age 40] Patients,” says Margolyes. But some insurers, particularly those offering government insurance plans, and some public health agencies and legislators, often rely on the USPSTF’s recommendations to guide their practices and policies, she added.
Most insurance plans cover mammography tests, but additional tests such as ultrasounds and magnetic resonance imaging (MRI) may vary by state or require insurance approval. Wong said the special committee recognizes that insurance coverage and testing costs are important, but those decisions are not under the special committee’s control and remain subject to payers, insurers and lawmakers. point out that it is under the jurisdiction of
How do I know if I have an increased risk of breast cancer?
Margolyes said starting testing at age 40 “saves more lives as long as the risk is not high.”
Medical organizations such as the American College of Radiology, along with breast experts such as Margolyes and Bee, are encouraging people to undergo a breast cancer risk assessment when they turn 25. Physicians use risk assessment tools. It’s like a “calculator” that calculates numbers. Patient medical history, family history, and reproductive history. If the results exceed a certain percentage, the person is considered to be at high risk of breast cancer.
Those at high risk “may need more than screening mammograms. We may need to start sooner. We may need additional MRIs or additional ultrasounds.” says Margolyes. “So this is a complicated message.”
Two-dimensional imaging mammograms are the cornerstone of breast cancer screening. Additionally, a three-dimensional mammogram, or digital breast tomosynthesis, uses multiple his x-ray images to create a more complete picture of the breast, Wong says. Additional screening techniques look at tissues differently. An ultrasound machine creates images by bouncing acoustic waves off body tissues. MRI injects dyes that help visualize tissues and blood vessels in greater detail. “If you just had an ultrasound, you’d find some cancers that a mammogram wouldn’t, and an MRI would find a lot more,” explains Margolyes. . “I would recommend an MRI for women at highest risk.”
Two factors considered during risk assessment are history of chest radiation exposure from age 10 to 30 years and breast tissue density. Before and after menopause (usually between the ages of 45 and 55), breast tissue usually becomes less dense and more fatty. Cancerous tissue is most often found in adipose tissue and appears as white spots or shadows on mammograms. On the other hand, dense tissue hides some cancers on a mammogram. And cancer is more likely to arise in dense tissue (experts are still trying to figure out why)). Wong says younger women tend to have denser breasts. About 50% of women in their 40s and 40% of women in their 50s are believed to fall into this category.
Doctors also ask whether any first-degree family members (such as parents or siblings) or relatives (such as aunts, grandparents, or cousins) have had any type of cancer. More specifically, people with a family history of genetic mutations. BRCA1 and BRCA2 Genes important in suppressing tumors and suppressing aberrant cell proliferation are associated with an increased risk of breast cancer. Certain groups, such as Ashkenazi Jews and blacks, BRCA mutation.
“Black women are twice as likely to be diagnosed with triple-negative breast cancer,” says Dr. Bee. This breast cancer is an invasive cancer that spreads rapidly and has few treatment options. “Triple-negative breast cancer is associated with sub-Saharan and West African ancestry. It’s in your genes.”
According to a 2021 study published in the journal cancer, Women of racial or ethnic minorities are 127 percent more likely to die of breast cancer before age 50 than non-Hispanic white women. A 2019 study also found that black women were 42 percent more likely to die from breast cancer and more likely to be diagnosed at a later stage of the disease, despite similar diagnosis rates. There are several reasons for these disparities, Bee said. In addition to genetic and biological risk factors, black women and members of other minority groups face significant barriers to quality care. “Chaos leads to mistrust, and systemic racism leads to mistrust,” says Bee. “Mistrust in the health system has bad consequences. We really need to have a unified approach to more personalized care.”
Bee also recommends that women who feel anxious or nervous about breast exams and risk assessments go with a trusted friend or family member. “All women should be empowered to know what their risks are and start assessing risk at age 25,” Bee said. “It is imperative that anyone conducting these assessments is aware of the intricate details of breast cancer and breast cancer inequality in the United States.”
The USPSTF proposal currently contains specific guidance on whether black women, members of other racial groups, or women with dense breast tissue may benefit from adopting different strategies or screening before age 40. is not included.
How often should I be tested?
Although some medical organizations recommend annual mammograms, the USPSTF’s proposal calls for average-risk women to have mammograms every other year. The task force said there was not enough evidence to show the benefits of annual screening for people in their 40s. Some experts, including Bee and Margolyes, argue that testing every two years isn’t enough. Margolyes said lowering the screening age to 40 is a good first step, but added that young women are more likely to develop aggressive, rapidly growing breast cancer. “Biennial screenings don’t make sense,” says Margolyes. “We are lowering the age of screening according to the Task Force to Detect Fast Growing, More Aggressive Cancers. People in their 40s will need it every year. You will miss the opportunity.”
Bee has expressed similar concerns for her patients. [subscribe] It can take up to two years to use a perfectly invented tool (which we know can be found early on) because there wasn’t enough evidence. “
Concerns about false positives and overdiagnosis have been raised when mammography is obtained too early or too often. For example, if you’re getting imaging tests twice as often as he is, the risk of false positives increases, prompting clinicians to order more expensive follow-up tests such as ultrasounds, MRI scans, and even biopsies. Increased risk. “Maybe some more cancer cases will be detected. [through screening every year]But it wasn’t clear if it would bring much benefit,” Wong said. An incorrect diagnosis can also “cause anxiety and cause anxiety,” he says.
Experts like Margolyes don’t think temporary discomfort should outweigh finding cancer more easily. “How can you equate anxiety with the possibility of dying from breast cancer, whether it’s minutes or days? It just doesn’t make sense,” she says.
Wong emphasized that the task force’s recommendations build on that, and that the group is seeking further research to determine whether additional screening after routine mammography will help. The USPSTF is accepting public comments on recent proposals for mammography screening through June 6. Task force members will also continue to monitor national data and trends as information becomes available. Ultimately, the researchers answered the big question on the minds of researchers and clinicians: What is driving the rising incidence of breast cancer at younger ages? We want to be thinking.
“I think our lifestyle, our weight, the substances in our environment all combine to increase the risk of breast cancer, but we don’t know for sure,” says Margolyes. “Maybe in the end he will find 35 to be right. Maybe 40 is too old. These are questions he will have to answer over the next 10 or 20 years. ”
*Editor’s Note (June 2, 2023): This sentence was edited after posting to clarify previous recommendations of the United States Task Force on Preventive Services.
