JAMA

USPSTF final recommendation: Start screening for breast cancer at age 40

May 1, 2024

USPSTF now recommends biennial screening mammography for women ages 40 to 49 years vs. individualizing the decision to undergo screening for women in this age group as had been previously recommended. Otherwise, this latest recommendation is consistent with the 2016 USPSTF recommendation on screening for breast cancer:

Women ages 40 to 70 years:

• The Task Force concludes with moderate certainty that biennial screening mammography in women ages 40 to 74 years has a moderate net benefit (B statement).
• Both digital mammography and digital breast tomosynthesis (DBT, or "3D mammography") are effective mammographic screening modalities.
• To achieve the benefit of screening and mitigate disparities in breast cancer mortality by race and ethnicity, it's important that all persons with abnormal screening mammography findings receive equitable and appropriate follow-up evaluation and additional testing, inclusive of indicated biopsies, and that all persons diagnosed with breast cancer receive effective treatment.

Women 75 years or older:

• USPSTF concludes that the evidence is insufficient (I statement) to determine the balance of benefits and harms of screening mammography in women 75 years or older.
• Clinicians should use their clinical judgment regarding whether to screen for breast cancer in women in this age group.

Women with dense breasts:

• USPSTF concludes that the evidence is insufficient (I statement) to determine the balance of benefits and harms of supplemental screening for breast cancer with breast ultrasound or MRI, regardless of breast density.
• Clinicians should use their clinical judgment regarding whether to use supplemental screening in women who have dense breasts and an otherwise normal mammogram.

To whom does this recommendation apply?

These recommendations apply to cisgender women and all other persons assigned female at birth (including transgender men and nonbinary persons) 40 years or older at average risk of breast cancer. They also apply to women who have factors associated with an increased risk of breast cancer, such as family history of breast cancer (ie, a first-degree relative with breast cancer) or having dense breasts.

These recommendations do not apply to persons who have a genetic marker or syndrome associated with a high risk of breast cancer (eg, BRCA1 or BRCA2 genetic variation), a history of high-dose radiation therapy to the chest at a young age, or previous breast cancer or a high-risk breast lesion on previous biopsies.

What additional info for clinicians:

USPSTF asserts that there are pronounced inequities in breast cancer stage at diagnosis, subtype, and mortality. Black women are more likely to be diagnosed with breast cancer beyond stage 1, are more likely to be diagnosed with triple-negative cancers (ie, ER-, PR-, and HER2-), which are more aggressive tumors, and are approximately 40% more likely to die of breast cancer compared with White women.

Among all U.S. women, breast cancer is the second most common cancer and the second most common cause of cancer death. In 2023, an estimated 43,170 women died of breast cancer. Non-Hispanic White women have the highest incidence of breast cancer (5-year age-adjusted incidence rate, 136.3 cases per 100,000 women) and non-Hispanic Black women have the second highest incidence rate (5-year age-adjusted incidence rate, 128.3 cases per 100,000 women).

Source:

US Preventive Services Task Force; Nicholson W, et al. (2024, April 30). JAMA. Screening for Breast Cancer US Preventive Services Task Force Recommendation Statement. https://pubmed.ncbi.nlm.nih.gov/38687503/