Experts cite 'urgent need' for changes to USPSTF breast cancer screening recommendations
Additional organizations in the women’s health space are joining others to voice their disappointment with the United States Preventive Services Task Force’s (USPSTF) draft recommendations pertaining to changes in breast cancer screening.
DenseBreast-info.org (DBI) and the Journal of Breast Imaging, the official journal of the Society of Breast Imaging, both released statements this week contesting multiple aspects of the draft recommendations, including the matter of how often women should undergo screening and the task force’s omission of guidelines relative to supplemental screening for women with dense breasts.
The DBI statement described the recommendations as “disappointing,” noting that the USPSTF’s update suggests that women should screen every other year when their own modeling studies have cited the benefits of annual screening. This recommendation could be especially consequential for the development of interval cancers in between screenings.
“Widening that gap to two years gives those cancers more time to develop and grow and interval cancers tend to be more aggressive with worse outcomes than those found on the screening mammogram,” the DBI statement reads.
Although the USPSTF update pertains specifically to women at average risk of developing cancer, the draft did briefly touch on the matter of dense breast tissue—a known factor that increases a woman’s risk of developing cancer and also having their cancer missed on mammograms. The draft excludes recommendations that women with dense breast tissue be referred for supplemental imaging, such as ultrasound or MRI, despite mounting evidence supporting the need for additional exams in that population. Regarding this decision, USPSTF cited “inadequate” evidence—evidence that Wendie Berg, MD, PhD, with the department of radiology at Magee-Womens Hospital of UPMC in Pittsburgh, and colleagues were happy to provide USPSTF with in their opinion article published in the Journal of Breast Imaging (JBI).
The group cited numerous studies with ample evidence to support their call for USPSTF to update their recommendations, noting that such changes would expand coverage to women who need it the most.
“As insurance may not cover screening not recommended by the USPSTF, this needs to be addressed. People will be told the mammogram is limited in women with dense breasts, and that other imaging tests can help, but affected women may be unable to get additional such imaging tests due to lack of insurance coverage,” the JBI article notes, adding that this would limit supplemental imaging availability solely to those with substantial resources.
Katie Couric, a breast cancer survivor herself, also addressed the USPSTF’s lack of additional guidance for women with dense breasts. Couric shared a clip of herself encouraging others to speak out on the topic during the open commenting period for the draft recommendations. That comment period ends on June 5, 2023.
“With expanded USPSTF recommendations including screening women in their 40s, the FDA final rule requiring women to be told if they have dense breasts, the prevalence of dense breasts in younger women, higher risk of missed cancer on mammography in dense tissue, and proven benefits of supplemental MRI especially, there is urgent need for uniform standards of insurance coverage to assure all women have equal opportunity for early detection of breast cancer,” the JBI article concluded.
Comments on the draft can be submitted here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.