USPSTF breast cancer screening update echoes 2009 recs, sticks with biennial screening for women 50-74

The U.S. Preventive Services Task Force (USPSTF) largely stuck to its guns in a draft update to its breast cancer screening recommendations, suggesting routine biennial screening only for women ages 50-74.

This recommendation hems closely to USPSTF’s 2009 recommendations, though the 2015 update does acknowledge that women with a family history of breast cancer may benefit from screening starting at age 40 and that this should be an individual decision made in consultation with a physician.

“Women who place a higher value on the potential benefit than the potential harms may choose to begin screening between the ages of 40 and 49 years,” read a statement on the USPSTF website.

Backing up its recommendation for a more conservative screening strategy, the USPSTF cited data from the Breast Cancer Surveillance Consortium that showed starting biennial screening at age 40 as opposed to age 50 would result in one additional breast cancer death averted for every 1,000 women screened, but would also lead to two additional overdiagnosed tumors, 58 unnecessary biopsies and 576 additional false-positive tests.

As with the 2009 recommendations, the 2015 update will be a lightning rod for criticism from those advocating a more aggressive screening approach. The American Cancer Society and other groups recommend yearly mammography screening beginning at age 40.

A statement released by the American College of Radiology (ACR) didn’t mince words, stating unequivocally that if they were adopted, the USPSTF draft recommendations would result in thousands of additional breast cancer deaths each year.

“The USPSTF limited its consideration to studies that underestimate the lifesaving benefit of regular screening and greatly inflate overdiagnosis claims,” said Barbara Monsees, MD, FACR, chair of the ACR Breast Imaging Commission, in the statement. “They ignored more modern studies that have shown much greater benefit. These limitations result in the misrepresentation of the real trade-offs that women and health care providers need to know about in order to make good decisions about screening. They also ignored the demonstrated views of American women on screening. Unfortunately, these recommendations will only add to confusion that is placing women at risk.”

The ACR also said the USPSTF does not comply with Institute of Medicine recommendations for guideline development, and as such should not be considered “trustworthy guidelines.”

Coverage concerns

The task force’s draft recommendations give a “B” recommendation to screening mammography every two years for women ages 50-74 and a “C” recommendation for screening of women ages 40-49, which could impact access to screening.

Under the Affordable Care Act, private insurers must cover, without copay, procedures given a grade “B” or higher by the USPSTF. As currently drafted, this would mean millions of women would not be guaranteed coverage, according to the ACR.

“We believe that the Secretary of the U.S. Department of Health and Human Services can clarify now whether adoption of these USPSTF recommendations would mean that private insurers no longer have to cover mammograms for millions of women 40-49 who, together with their doctor, choose to have regular mammograms and those 50-74 who choose to be screened annually,” said Bibb Allen, MD, FACR, chair of the ACR Board of Chancellors. “We call on her to affirm that coverage will not be affected.”

The UPSTF also looked at tomosynthesis as a screening modality and the question of whether women with dense breast should receive supplemental screening with MRI or ultrasound, but stated there was not enough evidence to make a determination of the benefits and harms in these areas.

The draft guidelines will now be subject to a 30-day comment period.

You can learn more about the recommendations from the USPSTF website, and view a video message discussing the topic from Kirsten Bibbins-Domingo, MD, PhD, in the clip below: