Women ages 50 to 74 should be screened regularly; women in their 40s should make an individual decision in partnership with their doctors.
The U.S. Preventive Services Task Force published a final recommendation statement on screening for breast cancer following an in-depth review of the science on the benefits and harms of screening mammography, and a detailed review of input received from the public and health care professionals on its 2015 draft recommendation. The Task Force - an independent, volunteer panel of experts in evidence-based medicine -examined the evidence on women who were not known to be at increased risk of breast cancer. The recommendation statement, which is published in Annals of Internal Medicine, is made up of several recommendations addressing different age groups and screening methods, and is accompanied by an editorial on how its findings converge with guidelines from other organizations.
The Task Force confirmed that screening mammography is effective in reducing deaths due to breast cancer among women ages 40 to 74 years. The greatest benefit of screening mammography occurs in women ages 50 to 74 years, and these women get the best balance of benefits to harms when screening is done every two years. This is a B recommendation.
For women in their 40s, the Task Force found that mammography screening every two years can also be effective and recommends that the decision to start screening should be an individual one, taking into account a woman's health history, preferences, and how she values the potential benefits and harms. Women in their 40s who have a mother, sister, or daughter with breast cancer may benefit more than average-risk women by beginning screening before age 50. This is a C recommendation.
While the Task Force noted that screening mammography is effective in reducing deaths from breast cancer for women in their 40s, the likelihood of benefit is less than for older women and the potential harms proportionally greater. The most serious potential harm of mammography screening is unneeded treatment for a type of cancer that would not have become a threat to a woman's health during her lifetime; the most common is a false-positive test result, which often leads to additional tests and procedures and may lead to anxiety and stress.
Finally, the Task Force identified a number of areas where additional research is needed to better understand how screening might reduce breast cancer deaths. Specifically, the Task Force concluded that evidence is insufficient to determine the balance of benefits and harms in three important areas: the benefits and harms of screening women age 75 and older; adjunctive screening in women with dense breasts; and the effectiveness of 3-D mammography for the detection of breast cancer. Due to this lack of evidence, the Task Force is unable to make a recommendation for or against these services. These are I statements. The Task Force strongly encourages additional research in these areas and notes that women should speak to their doctors to determine what is best for their individual needs.
It's important to note that the Task Force does not make recommendations for or against insurance coverage; coverage decisions are the responsibility of payers, regulators and legislators. Legislators recently extended a guarantee that women who have private insurance, beginning at age 40, will not have a co-pay for their screening mammogram. The role and mission of the Task Force is to provide all people with the best available information about the current science of prevention to empower them to make informed decisions about their health and health care.