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Bi-Annual Mammograms At Age 40 Now Recommended For Most Women, What The New Breast Cancer Screening Guidelines Mean For You

By Danielle Cinone,

17 days ago

The Importance of Breast Cancer Screenings

An important group called the U.S. Preventive Services Task Force has issued new finalized recommendations suggesting women with average breast cancer risk begin screening mammograms once every two years at the age of 40.
It’s important to note that women with the BRCA gene mutation, who have a family history of cancer, or have dense breasts are at higher risk and should talk with their doctor about when to begin screening. It may be younger than 40.
SurvivorNet experts recommend performing a monthly breast self-exam to look for anything unusual with your breasts because it can help catch breast cancer between regularly scheduled mammograms.
Breast density is determined through mammograms. However, women with dense breasts are at a higher risk for developing breast cancer because dense breast tissue can mask potential cancer during screening.
3D mammograms, breast ultrasound, breast MRI, and molecular breast imaging are options for women with dense breasts for a more precise screening. It is important to ask your doctor about your breast density and cancer risk.

Women who are at an average risk for breast cancer and between the ages 40 and 74 are being advised to get mammograms every two years, according to new finalized recommendations from an important advisory board called the U.S. Preventive Services Task Force (USPSTF) released Wednesday, and published in the Journal of The American Medical Association (JAMA) . In addition to suggesting women start bi-annual screenings at age 40, the USPSTF says there is not enough evidence to determine the positives and negatives of mammographies for women 75 years and older. The USPSTF also notes that there is insufficient evidence to understand "the balance of benefits and harms of supplemental screening for breast cancer using breast ultrasonography or magnetic resonance imaging (MRI) in women identified to have dense breasts on an otherwise negative screening mammogram." The new USPSTF guidelines mark a significant change from its

2016 recommendations , saying women should start biennial screenings at age 50. The guidelines apply to women with an average risk of breast cancer, including people with a family history of the disease and risk factors like dense breasts. However, the recommendation is not for anyone with a personal history of breast cancer, who have certain genetic factors putting them at high risk of the disease, who have had high-dose radiation to their chest, or who have had high-risk lesions on previous biopsies. In the wake of the finalized guidelines, Dr. Douglas Marks , a medical oncologist at NYU Langone Perlmutter Cancer Center, said in a statement to SurvivorNet, "Since the updated 'draft recommendations' on breast cancer released by USPSTF in May 2023, these guideline recommendations are now consistent with several medical societies which recommend initiation of screening at 40 years of age. "While all guidelines recommend regular screening (vs. sporatic screening) they still differ to a degree in the frequency interval (e.g. annual vs. biennial). The updated evidence overview provided by USPSTF, published in JAMA, underscores that regularity of screening is likely more important than the frequency of screening (1 vs. 2 years) for the majority of "normal risk" patients. It remains very important that patients determine, in conjunction with their doctor's, their individualized BC risk as these general guidelines may not be appropriate." https://twitter.com/JAMA_current/status/1785329529260593242 Dr. Marks continued, "The updated USPSTF report, published in JAMA, supports regular breast cancer screening below 74 years of age. These recommendations includes screening younger patients (40-50 years of age), who are at risk for higher risk for diagnosis with more aggressive subtypes of breast. The USPSTF report also provides a preliminary update on the impact of tomosynthesis and MRI on breast cancer screening outcomes. "Women between 40 and 50 years of age who have not undergone breast cancer screening already should discuss scheduling their initial screening with their health care providers."

Dr. Nancy Chan , a medical oncologist at NYU Langone Perlmutter Cancer Center, has also spoken out about the new guidelines, saying, "No significant difference was found in different screening methods: ie DBT vs digital mammogram. In patients with dense breast tissue addition of MRI may reduce cancer risk and false positive recalls." https://twitter.com/JAMA_current/status/1785329553423978874 "In clinical practice the majority of patients are undergoing annual screening with mammogram, instead of once every 2 year screening interval," she added. "Practically, In the urban setting most patients are already and will continue to have screening with mammogram with tomosynthesis. Each patient must consider the best screening method their individual cancer risk such as breast density family history etc." JAMA explains that the new recommendations raise awareness on the following issues: "health inequalities related to breast cancer outcomes and ensuring benefits for all women amid rapid screening advancements." https://www.youtube.com/watch?v=r6olpv75gnM

Expert Resources On Early Detection & Cancer Screenings

Additionally, the task force suggests in it's final recommendation statement , "We are also urgently calling for more research that will allow us to build on our existing guidance and help all women live longer and healthier lives. "Specifically, we need to know how best to address health disparities across screening and treatment experienced by Black, Hispanic, Latina, Asian, Pacific Islander, Native American, and Alaska Native women. We also need studies on what more should be done for women with dense breasts, and we need evidence on the benefits and harms of screening in older women.

Mammograms Are Still the Best Tool for Detecting Breast Cancer Meanwhile, Dr. Jeannie Shen, medical director of the Breast Program at Huntington Hospital, an affiliate of Cedars-Sinai, previously told SurvivorNet that she agrees with starting mammogram screenings for women with an average breast cancer risk at age 40. However, she doesn’t agree with that screening taking place every other year between 40 and 50, when “interval cancers (cancers which develop between screening mammograms) are more common.” According to Dr. Shen, one “important takeaway” from USPSTF’s new guidelines is that "these are only applicable to ‘average risk’ women." “Nowadays, as we are increasingly practicing personalized medicine, screening recommendations should be tailored to an individual woman's risk. Studies show there are ‘high risk’ women who may not realize they are ‘high risk.'” Dr. Shen explained. “There are statistical models which help practitioners determine an individual patient's risk of breast cancer. The most commonly used and accepted one is the IBIS (Tyer-Cuzik) model. So, patients should be encouraged to have these discussions with their physicians and their screening recommendations tailored to their individualized risk." Dr. Amy Comander, medical director and director of Breast Oncology at Mass General Cancer Center Waltham, also spoke with SurvivorNet in an earlier interview, but in support of the USPSTF's lowered age for mammograms. “This will encourage more women to get screened starting at age 40, so we can detect breast cancers earlier, and save more lives!” she said. She highlighted the fact that the incidence of breast cancer for women in their 40s has increased between 2015 and 2019,” and “other organizations such as the

American College of Radiology have already recommended that mammographic screening start at age 40, in order to provide the benefit. It is nice to see that the guidelines from the USPSFT are now in alignment with other organizations.”

Helpful Information About Breast Cancer Screening

The medical community has a consensus that women between 45 and 54 have annual mammograms. However, an independent panel of experts called the U.S. Preventive Services Task Force (USPSTF) is saying that women should start getting mammograms every other year at the age of 40, suggesting that this lowered the age for breast cancer screening could save 19% more lives. For women aged 55 and older, the American Cancer Society recommends getting a mammogram every other year. However, women in this age group who want added reassurance can still get annual mammograms. Women with a strong family history of breast cancer, have dense breasts, have a genetic mutation known to increase the risk of breast cancer, such as a BRCA gene mutation , or a medical history, including chest radiation therapy before age 30, are considered at higher risk for breast cancer. WATCH: Understanding the BRCA gene mutation Experiencing menstruation at an early age (before 12) or having dense breasts can also put you into a high-risk category . If you are at a higher risk for developing breast cancer, you should begin screening earlier. Breast density is determined through mammograms. However, women with dense breasts are at a higher risk for developing breast cancer because dense breast tissue can mask potential cancer during screening. 3D mammograms, breast ultrasound, breast MRI, and molecular breast imaging are options for women with dense breasts for a more precise screening. It is important to ask your doctor about your breast density and cancer risk. RELATED: 3D Mammography Detects 34% More Breast Cancers Than Traditional Mammography

Family History & Breast Cancer Risk

Although breast cancer can happen to anyone, certain factors can increase a person’s risk of getting the disease. The known risk factors for breast cancer include:

Older age
Having a gene mutation such as the BRCA1 or BRCA2
Added exposure to estrogen
Having children after the age of 30
Exposure to radiation early in life
Family history of the disease

RELATED: Is Genetic Testing Right for You? Different types of genetic testing can help people with a family history of cancer better ascertain their cancer risks. Your doctor will discuss your family history of cancer with you in the context of your type of tumor and your age at diagnosis. Hereditary genetic testing is usually done with a blood or saliva test. WATCH: Understanding genetic testing for breast cancer. About ten percent of breast cancers are hereditary, says Dr. Ophira Ginsburg , Director of the High-Risk Cancer Program at NYU Langone’s Perlmutter Cancer Center. "We encourage only those with a family history to get [genetic testing]," Dr. Ginsburg previously told SurvivorNet. "I would say that if you have anyone in your family diagnosed with a rare cancer. Or if you have a strong family history of one or two kinds of cancer, particularly breast and ovarian, but also colon, rectal, uterine, and ovarian cancer, that goes together in another cancer syndrome called the Lynch Syndrome. The second test involves the genetic sequencing of your tumor if you’ve been diagnosed with cancer by this point. These genetic changes can be inherited, but most arise during a person’s lifetime. This process usually involves examining a biopsy or surgical specimen of your tumor. This testing can lead to decisions on drugs that might work against your cancer. “Digital mammography, it turns out, significantly improves the quality of the mammogram… It’s 3D or tomosynthesis mammography,” Dr. Lehman explains. "This allows us to find more cancers and significantly reduce our false-positive rate. With digital mammography 3D tomosynthesis, we’re taking thin slices through that breast tissue, like slices of a loaf of bread. We can look at each slice independently rather than trying to see through the entire thickness of the entire loaf of bread. So those thin slices help us find things that were hidden in all the multiple layers,” Dr. Lehman adds. Additional testing can be considered for dense breasts, depending on a woman’s personal history, preferences, and her physician’s guidance.

Screening Options for Women with Dense Breasts

Women with dense breasts should get additional screening to supplement their mammograms. Dense breasts mean more fibro glandular tissue and less fatty breast tissue exists. The dense tissue has a "masking effect on how well we can perceive cancer and find cancer on mammograms," Dr. Cindy Ly, a radiology doctor at NYU Langone Medical Center, told SurvivorNet in an earlier interview. Survivors Encourage Women to Ask Their Doctors About Dense Breasts Glandular tissue within dense breasts appears white on mammograms, which can help mask potential cancer. The “frosted glass” effect from the glandular tissue can thus mask cancerous areas, especially developing ones. Undetected, these cancers can progress, growing large and advanced. They will then likely require more intensive treatments to cure or can become incurable altogether. Women with dense breasts may not know they have it based on feeling alone. It's important to know that breast density is determined by its appearance on a mammogram. Dr. Connie Lehman , the chief of the Breast Imaging Division at Massachusetts General Hospital, previously explained to SurvivorNet that fatty breast tissue appears gray on an X-ray. Conversely, dense breast structures appear white during an X-ray. Cancers also appear white on an X-ray, meaning the dense breast structures can mask the possibility of cancer. Luckily, advanced mammograms exist to help doctors navigate this obstacle. WATCH: 3D Mammograms explained. "Digital mammography, it turns out, significantly improves the quality of the mammogram…It’s 3D or tomosynthesis mammography,” Dr. Lehman explains. “This allows us to find more cancers and to significantly reduce our false-positive rate. With digital mammography 3D tomosynthesis, we’re taking thin slices through that breast tissue, like slices of a loaf of bread. We can look at each slice independently rather than trying to see through the entire thickness of the entire loaf of bread. So those thin slices help us find things that were hidden in all the multiple layers," Dr. Lehman adds. Additional testing can be considered for dense breasts, depending on a woman’s personal history, preferences, and her physician’s guidance. These tests include:

3-D Mammogram (Breast Tomosynthesis) : This technology acquires breast imaging from multiple angles and digitally combines them into a 3D representation of the breast tissue. This allows physicians to see breast tissue architecture better, even in dense breasts. 3D mammograms are fast becoming the standard way of performing mammography.
Breast Magnetic Resonance Imaging (MRI) : An MRI machine uses magnets to create highly detailed, intricate images of the breast. These are mostly reserved for women with an extremely high breast cancer risk. Dense breasts alone may not be a valid reason to obtain a breast MRI. However, dense breasts in women with genetic mutations, like BRCA1 and BRCA2, or a strong family history of breast cancer could justify obtaining breast MRIs.
Molecular Breast Imaging (MBI) : MBI is a newer imaging technique that uses a radioactive tracer to detect breast cancer. It is beneficial for women with dense breasts. However, MBI is not as widely available as other screening methods.

A new rule from the Food and Drug Administration (FDA) says that facilities offering mammograms must notify patients about their breast tissue density and recommend they speak with a doctor to determine if further screening is necessary. There will be “uniform guidance” on what language to use and what details must be shared with the patient to make the communication clear and understandable.

Breast Cancer Symptoms & Self-Exams

Women are encouraged to do regular self-exams to become familiar with how their breasts feel normally so something like a lump forming can be easily detected. A self-exam includes pressing your fingertips along your breast in a circular motion. If you feel something abnormal, such as a lump or discharge from the nipple, you should contact your doctor for further examination. Below are common symptoms to look out for:

New lump in the breast or underarm (armpit)
Any change in the size or the shape of the breast
Swelling on all or part of the breast
Skin dimpling or peeling
Breast or nipple pain
Nipple turning inward
Redness or scaliness of breast or nipple skin
Nipple discharge (not associated with breastfeeding)

Learn Your Risk and Listen to the Guidelines: An Important Message About Breast Cancer Awareness Contributing: SurvivorNet Staff

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