Empowering Women with Science
After an in-depth review of the strongest available science on the benefits and harms of screening mammography, as well as input from the public and health care professionals during the public comment period, the Task Force issued its final recommendations on breast cancer screening on January 12, 2016. You can learn more about how the Task Force’s final recommendations converge with other evidence-based guidelines in an editorial published in Annals of Internal Medicine.
Statement on ACOG’s Consensus Conference
The U.S. Preventive Services Task Force sent representatives to the American College of Obstetricians and Gynecologists’ Consensus Conference on January 28 to 29 to present the evidence that informed our 2016 final recommendations on screening for breast cancer. Our conference presentation is available here, so patients and health care professionals can learn more about the science we reviewed and our statements during the meeting. We are looking forward to this meeting and to having a constructive conversation that is focused on areas of agreement in order to best help women as they make decisions about their health care.
The Task Force is congressionally mandated to develop evidence-based recommendations that focus on preventive services provided in the primary care setting. While we value the important discussions that will take place in this conference, particularly those that will communicate to patients and clinicians the areas of agreement among our organizations, the Task Force’s processes require that our guidelines be based on the scientific evidence and do not permit us to sign on to consensus guidelines. We are encouraged by the strong convergence among the Task Force, the American Cancer Society, and other conference participants around the following points and hope that they are communicated effectively. In our view, important areas of convergence include:
- Mammography is an important tool to reduce breast cancer mortality.
- The benefits of mammography increase with age, with the greatest benefit for women between the ages of 50 and 74.
- Women in their 40s have the potential to benefit from mammography screening. While there is variation in the specifics across guidelines, many endorse that women should make their own decision about whether to start mammography in their 40s in consultation with their doctors. Women should consider both the potential benefits and the potential harms of screening and, together with clinicians, make the decision about when to start screening based on her health history, preferences, and how she values the different potential benefits and harms of screening.
- There is not a “one size fits all” approach regarding the age at which to end mammography screening. For women age 75 and older, there is not enough evidence about the overall benefit of mammography screening, and these women should talk with their doctor to determine what is best for their individual health needs, values, and preferences.
As primary care clinicians and researchers, we hope that this conference will facilitate greater dialogue between women and their doctors so they can make informed health care decisions. We also hope it will lead to additional research addressing important evidence gaps in the science of breast cancer screening.
Women ages 50-74
The USPSTF recommends screening mammography every 2 years for women ages 50 to 74 years.
Women ages 40-49
The decision to start screening mammography in women before age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harms, may choose to begin screening every 2 years between the ages of 40 and 49 years. C recommendation
Women 75 and older
The current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women age 75 years and older.
Frequently Asked QuestionsView All Questions
How do the Task Force’s recommendations compare with recent guidelines from others?
The Task Force, the American Cancer Society, the American College of Physicians, the American Academy of Family Physicians, and the Canadian Task Force on Preventive Health Care all recommend individualized decision-making for women in their 40s. They all agree that women should be empowered to make informed, evidence-based decisions about breast cancer screening, together with their doctor.
What does this final recommendation mean for insurance coverage?
The Task Force does not make recommendations for or against insurance coverage. Through a unique provision of federal law, legislators guaranteed that women in their 40s who have private insurance will not have a co-pay for their screening mammogram. Coverage of mammography for Medicare beneficiaries was established by another statute and is not bound by the Task Force’s recommendations. The Task Force recently authored a Viewpoint in the Journal of the American Medical Association to clarify how its recommendations are linked to the Affordable Care Act coverage mandate, and to reiterate how it believes clinicians, payers, and the public should interpret its recommendations. This Viewpoint is available here.
Is a C grade a recommendation against screening?
No. A C grade is a positive recommendation that recognizes a small net benefit: mammograms can help women in their 40s reduce their risk of dying from breast cancer.
Because the risk of developing breast cancer is lower for women in their 40s, the likelihood of benefiting from mammography is smaller, and the risk of harm is proportionally greater than in women ages 50 to 74. As a result, the Task Force recommended that the decision to initiate screening at ages 40 to 49 years be an individual one based on a woman’s preferences and her personal and family health history, and issued a C recommendation. Women in their 40s who have a mother, sister, or daughter with breast cancer are at increased risk of developing breast cancer, and may benefit more than average risk women by beginning screening before age 50.
What’s the difference between this recommendation and the 2009 recommendation?
For the first time, the Task Force looked at the effectiveness of digital breast tomosynthesis (3D mammography) as a way to screen for breast cancer. While 3D mammography is an emerging technology, there is very little evidence available that examines the ultimate effectiveness of this newer screening method, and therefore, the Task Force was unable to make a recommendation for or against its use.
This is also the first time that the Task Force looked at the effectiveness of additional screening for women who are known to have dense breasts but an otherwise negative mammogram. The evidence on how additional screening with an ultrasound, MRI, or 3D mammography may or may not help women with dense breasts is unclear. Therefore, the Task Force cannot make a recommendation for or against additional screening. These are all important areas for future research.
In 2015, the Task Force reviewed studies of analog (film) mammography as well as more recent observational evidence about the efficacy of digital mammography, and the modeling data also looked at digital mammography. The Task Force is using all available evidence, including models, to help guide women and their screening decisions.