A national health panel has recommended lowering the age for routine screening mammograms by 10 years, now advising women ages 40 to 74 at average risk of breast cancer to get screened every two years.
Previously, the guidance from the U.S. Preventive Services Task Force was for women to make individual screening decisions in their 40s but start no later than 50.
The change has left many women with questions about how the new guidance affects their personal health. We spoke with experts to get answers.
Why were the mammogram guidelines changed?
Cancer rates among younger Americans are on the rise. And more women in their 40s are getting breast cancer, with the number of newly diagnosed women increasing about 2% each year, said John Wong, an internist and professor of medicine at Tufts University School of Medicine, who is a vice chair on the task force.
Black women are more likely than white women to be diagnosed with breast cancer at a younger age and more likely to be diagnosed with an aggressive form called triple-negative breast cancer. They are also about 40% more likely to die of breast cancer than white women, research shows.
Overall, more than 42,000 women die of breast cancer each year in the United States, data shows.
The task force proposed the new guidelines last year to address the rising breast cancer rates among younger women and also mitigate racial disparities, and has now formally approved the advice.
“It could potentially save as many as 1 in 5 women, or 20%, from dying from breast cancer,” Wong said.
Why aren’t older women advised to get screened?
The task force concluded there wasn’t enough evidence to assess the benefits vs. harms for screening mammograms for women older than 74. Potential harms include false positives that may take a psychological toll and lead to unnecessary follow-up tests and procedures, as well as the added – yet minimal – radiation exposure, the task force noted.
What are the screening recommendations for women with dense breasts?
Guidance for women with dense breasts was also inconclusive in some ways. While all women are encouraged to start screening mammograms at age 40, mammograms may not be as effective for women with dense breasts, who make up nearly half of women 40 and older who get screened, research shows.
The task force did not find enough evidence for supplemental screenings such as ultrasounds or MRIs for women with dense breasts.
Women at high risk of developing breast cancer – including those who have a genetic marker or syndrome associated with a high risk of breast cancer such as BRCA1 or BRCA2 genetic variation – are not covered by the new task force recommendations. In 2019, the task force advised that primary care providers assess women who are considered high risk and, when indicated, prescribe genetic counseling and then, if needed, genetic testing. In these cases, private insurers and state Medicaid expansion programs are required to cover the cost for the counseling and testing.
Will the new guidelines change insurance coverage for mammograms?
Most insured women in the United States are already covered for annual screening mammograms without cost-sharing starting at age 40 based on existing guidelines from independent medical and scientific recommending bodies.
“The task force recommendation is not going to change what insurance plans are required to cover,” as far as mammograms are concerned, said Alina Salganicoff, a senior vice president and director of the Women’s Health Policy Program at KFF, formerly the Kaiser Family Foundation.
Women who qualify for Medicaid expansion are subject to the same coverage rules as the private insurance plans. For women who are not part of the expansion program, the scope of coverage is up to the states.
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