epocrates

Podcast Recap | JAMA Clinical Reviews: USPSTF's updated recommendation for breast cancer screening

May 16, 2024

In this episode of the JAMA Clinical Reviews podcast, Dr. Wanda K. Nicholson, Professor of Preventive and Community Health at the Milken Institute School of Public Health at George Washington University and Chair of the USPSTF talks about the new breast cancer recommendation statement, which she co-authored, and the task force’s rationale for the update. Nicholson shares her insights into the evidence behind the new recommendation, its importance for Black women, and the need for additional research on the benefits of supplemental screening for women with dense breasts.

4 Key Takeaways:

1. The USPSTF now recommends biennial breast cancer screening for all women ages 40 to 74 years (Grade B recommendation).

The USPSTF’s latest breast cancer screening guidelines advise all women to get screened for breast cancer every other year starting at age 40 and continuing through age 74. This is a change from the 2016 recommendation, which advised women begin screening at age 50, and prior to that, consult with their clinician. According to Nicholson, this new recommendation could potentially save up to 20% more lives.

2. The rationale for the updated recommendation is based on the latest evidence and data from collaborative modeling studies.

Nicholson points to the rising incidence of breast cancer, which has been increasing by roughly 2% each year since 2015 among women ages 40 to 49 years. That data point, coupled with the latest information from the Breast Cancer Surveillance Consortium and collaborative modeling studies, clearly demonstrated that the benefits of earlier screening outweigh the harms. And, although no randomized trials compare annual to biennial screenings, collaborative modeling studies demonstrated that annual mammograms carry a 50% higher false positive rate than biennial screenings. “Our goal is to balance those benefits and harms, and annual screening actually placed individuals at a greater harm with those false positive results,” explained Nicholson.

3. The USPSTF found that current evidence is insufficient to assess the balance of benefits and harms of supplemental screening for women with dense breasts on an otherwise negative screening mammogram.

Over 40% of women in the U.S. have dense breasts, placing them at an increased risk for breast cancer. Research suggests that mammography alone is not well suited to detect cancer in these cases. However, Nicholson explained that evidence is lacking to determine if combining mammography with MRI or ultrasound offers a stronger screening strategy for women with dense breasts compared with mammography alone. The task force calls for more studies to better understand whether supplemental screenings could benefit women with dense breasts. In the meantime, women with dense breasts should talk with their clinicians about follow-up testing options.

4. The new breast cancer screening recommendation is especially important for Black women due to higher mortality rates.

Black women, who are 40% more likely to die from breast cancer than White women, may benefit the most from the new guidelines. Ensuring Black women start screening at age 40 is an important first step, but is not enough to improve the existing inequities. “Screening is such an important, obvious first step, but we know that the downstream steps of follow-up, appropriate biopsies if indicated, and access to equitable treatments are also crucial for all women, but particularly Black women, to really receive this benefit of this letter grade B recommendation,” said Nicholson.

Any views, thoughts, and opinions expressed in this podcast recap are solely that of the hosts and guest and do not reflect the views, opinions, policies, or position of epocrates and athenahealth.

Source:

Bibbins-Domingo, K. (Host). (2024, April 30). JAMA Clinical Reviews. USPSTF Recommendation: Screening for Breast Cancer [Audio podcast episode]. https://podcasts.apple.com/us/podcast/uspstf-recommendation-screening-for-breast-cancer/id1027430378?i=1000654062012