There’s a breast cancer epidemic happening among young women that needs your attention.
If you have breasts or love someone who does, listen up. There’s a breast cancer epidemic happening right now, increasing about 2% per year since 2015. More than 2.3 million people receive a breast cancer diagnosis annually; of those, more than 700,000 cases are fatal. And unfortunately, many breast cancer experts like myself believe that the latest screening recommendations from the U.S. Preventive Task Force (USPTF) are a major step backward when it comes to saving the most lives possible.
Last month, the USPTF released a new draft with its latest breast cancer screening guidelines, recommending that average-risk women from ages 40 to 74 years get a screening mammography every 2 years. (According to the draft, there’s “insufficient evidence” to recommend for or against screening mammography beyond age 74.)
These recommendations partially reverse the task force’s 2016 guidelines, which changed the longstanding breast cancer screening age from annual appointments starting at 40, to a screening every 2 years starting at 50. These discrepancies have caused confusion and misinformation ever since.
The good news? The public still has time to comment on the proposed recommendations via the USPTF’s website before they’re finalized: You can submit your thoughts until midnight today, Tuesday, June 6th. That seemingly simple act is important to me both professionally, as a board-certified breast radiologist and breast health advocate, and personally, as a 40-something woman with a strong family history of breast cancer and genetic mutations.
Here are the five key areas missing from the USPTF breast cancer screening recommendations that I believe need to be included:
Annual screening mammography at age 40 in average-risk women.
Two-year intervals are too long, especially in young women and minorities who are more likely to develop aggressive breast cancers, have dense breast tissue, and die from their breast cancer. Skipping a year of mammography can lead to delays in diagnosis and worse outcomes; we learned this the hard way during the COVID-19 pandemic.
Annual mammography saves the most lives, period. And even the USPTF acknowledges this. The reason they’re not recommending annual mammography is because of high false-positive callbacks (return appointments) in young women, which may lead to extra imaging tests and biopsies that can cause anxiety. But we don’t place the same paternalistic approach to prostate cancer screening, so why breast cancer? Cancer screening recommendations should reflect the most life-saving information, and let individuals decide what to be anxious about.
Education about breast cancer risk factors & high-risk screening.
The proposed recommendation only applies to average-risk women, but we need breast cancer risk assessment for all women by age 30 — and earlier and supplemental screening for high-risk individuals (aka anyone with a greater than 20% lifetime risk of breast cancer).
Supplemental screening for women with dense breast tissue
Adding ultrasound or MRI to an annual mammogram helps us find earlier, more treatable breast cancers in women with dense breast tissue (meaning it’s heterogeneously or extremely dense, by mammography). We need insurance coverage for this, too!
No age to stop screenings
We should continue to screen up to 5 to 7 years before typical life expectancy. Breast cancer is more common and mammography is more accurate as you get older, so why stop at age 74? Plus there are constantly evolving, less aggressive treatments that are optimal for the older population.
Recommendations that apply beyond cisgender women
Welcome to the 21st century! Let’s not forget about high-risk individuals — including men, nonbinary, and m-to-f transgender individuals who’ve undergone hormone replacement and already face delayed diagnosis and worst-case outcomes.
Annual mammography in average-risk women saves the most lives, but high-risk individuals need more frequent screening. Anything else prioritizes anxiety and fear of false positives over early breast cancer detection. The USPTF’s proposed recommendations are a step backward and only add to the confusion and misinformation regarding breast cancer screening.
Now’s the time to speak up: We have the power to make a change together. You can comment on these guidelines anytime before midnight tonight (Tuesday, June 6th) at the link below that these factors above must be included. So make your voice heard — while there’s still time.
Dr. Robyn Gartner Roth is an Ivy League-trained radiologist specializing in breast imaging. She runs a popular breast health social media account, @theboobiedocs, and a podcast, The Girlfriend’s Guide to Breast Cancer, Breast Health, and Beyond.
