USPSTF Updates Mammography Screening Recommendations (April 2024)

USPSTF Updates Mammography Screening Recommendations

Take Home

The U.S. Preventive Services Task Force (USPSTF) recommends biennial screening mammography for women aged 40 to 74 years due to moderate benefits in reducing breast cancer mortality. They conclude that evidence is insufficient to recommend for or against screening in women aged 75 and older or to endorse supplemental screenings like MRI or ultrasound, regardless of breast density. They emphasize the importance of equitable and appropriate follow-up care across all demographics to mitigate disparities in breast cancer mortality.

Evidence Source

The USPSTF based its recommendations on data from a systematic review of mammography-based breast cancer screening strategies and complementary collaborative modeling studies. These studies evaluated the effectiveness of various screening intervals, modalities, and supplemental imaging on cancer incidence, progression to advanced cancer, morbidity, and mortality. They also reviewed observational data from the Breast Cancer Surveillance Consortium, which provided a substantial observational database related to breast cancer screening. Unfortunately, no RCTs evaluated screening in women over 75 years old and thus firm conclusions of benefits in this population could be made.

Magnitude of Benefit/Harm

With any screening assessments the benefits of early detection and improved disease specific mortality need to be weighed agains the harms of false positives and subsequent psychological harm and unnecessary invasive interventions.

Mortality Benefit

A meta-analysis conducted in support of the 2016 USPSTF breast cancer screening recommendation found that screening mammography was associated with relative risk (RR) reductions in breast cancer mortality of 0.88 (95% CI, 0.73-1.00; 9 trials) for women aged 39 to 49 years, 0.86 (95% CI, 0.68-0.97; 7 trials) for women aged 50 to 59 years, 0.67 (95% CI, 0.54-0.83; 5 trials) for women aged 60 to 69 years, and 0.80 (95% CI, 0.51-1.28; 3 trials) for women aged 70 to 74 years,and an updated analysis of 3 Swedish screening trials reported a 15% relative reduction in breast cancer mortality for women aged 40 to 74 years (RR, 0.85 [95% CI, 0.73-0.98]).

Screening Interval

Collaborative modeling estimated that biennial screening results in greater incremental life-years gained and mortality reduction per mammogram and has a more favorable balance of benefits to harms for all women and for Black women, compared with annual screening. While modeling suggests that screening Black women annually and screening other women biennially would reduce the disparity in breast cancer mortality

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