The U.S. Preventive Services Task Force affirmed that women ages 50 to 74 should have a mammogram every two years. Screening for women in their 40s should be an individualized decision, the panel said in draft recommendations that drew immediate fire from radiologists.
“We continue to recognize that mammography is a critical tool in the fight against breast cancer,” Dr. Kirsten Bibbins-Domingo, USPSTF co-vice chair, said in a video announcement of the panel's draft recommendations.
The American College of Radiology and the Society of Breast Imaging said the recommendations, if adopted, could cost thousands of lives and the loss of insurance coverage for beneficial preventive screenings.
But Bibbins-Domingo said the risk for breast cancer increases with age, so the value of having a mammography increases as well, adding that the evidence shows that the best balance of potential benefit to harm is to have one every two years.
The studies on breast-cancer screening have not included women 75 and older, so she said the task force could not make a recommendation either way for this group.
“The science shows that some women in their 40s will benefit from mammography, most will not,” the USPSTF said in a news release. Women who have a mother, sister or daughter with breast cancer, may benefit more than other women at average risk.
The potential harms outweigh the benefits for women ages 40 to 49, according to the USPSTF. For women in this group, the panel recommends “informed, individualized decisionmaking based on a woman's values, preferences, and health history.”
Bibbins-Domingo emphasized that these guidelines are aimed at women 40 and older with no signs or symptoms of breast cancer, no previously diagnosed high-risk breast cancer lesion, no known genetic history of breast cancer, and no history of being exposed to chest radiation at a young age.
There is also insufficient evidence to assess the benefits or harms from digital breast tomosynthesis technology, also known as 3-D mammography, according to the draft recommendations.
The most serious harm associated with mammography that was cited by Bibbins-Domingo was overdiagnosis or the receiving of treatment for a type of cancer that would not pose a threat to a woman's health. The most common harm was receiving a false positive test result that led to more tests and to unnecessary procedures.
The American College of Radiology and the Society of Breast Imaging warned that the guidelines, if adopted, could mean women ages 40-49 could lose access to free breast cancer screenings granted under the preventive care provision of the Affordable Care Act. HHS requires that health plans provide first-dollar coverage for mammograms for women 40 and older.
The groups cited a 2014 JAMA Internal Medicine study that described the anxiety experienced by patients who receive false positives as "short term" and "time-limited harm."
“The USPSTF limited its consideration to studies that underestimate the lifesaving benefit of regular screening and greatly inflate overdiagnosis claims," Dr. Barbara Monsees, chair of the ACR Breast Imaging Commission, said in a news release. "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."
Dr. Richard Wender, chief cancer control officer of the American Cancer Society, pointed out in a response to the guidelines that the USPSTF's “C” rating for screening of women in their 40s “is not a recommendation against mammography.”
“While empowering women to make an informed decision about screening is laudable and something that the American Cancer Society also recommends, we are concerned that the 'C' rating might lead to coverage for fewer women and more out of pocket costs for women in their 40s,” Wender said. “Costs should not be a deterrent to women who otherwise would seek to have a mammogram.”
The public is invited to submit comments through May 18.