Breast cancer: United States has new age recommendation for starting routine mammography; see which one is it?

Due to rising rates of breast cancer in young women, the United States Preventive Services Task Force recommended this week that mammograms be performed starting at age 40. The decision reverses long-standing guidance that most women wait until 50.

The government institution, which has a panel of experts, finalized a draft recommendation made public last year. The group issues influential advice on preventive health, and its recommendations are generally widely adopted across the country.

In 2009, the task force raised the age to start routine mammograms from 40 to 50, sparking widespread controversy. At the time, researchers were concerned that early screening could do more harm than good, leading to unnecessary treatments in younger women, including alarming findings that lead to invasive but ultimately unnecessary procedures.

However, currently rates of this cancer among women in their 40s have shown an increase of 2% per year between 2015 and 2019, according to John Wong, vice president of the working group. The panel continues to recommend screening every two years for women at average risk, although many adopt annual exams.

“There is clear evidence that starting screening every two years at age 40 provides enough benefits that we should recommend it to every woman in this country to help them live longer and have a better quality of life,” says the clinician of Tufts Medical Center and director of comparative effectiveness research.

In Brazil, the Ministry of Health recommends carrying out a breast examination using digital mammography every two years from the age of 50 onwards. The Brazilian Society of Mastology (SBM), the Brazilian College of Radiology and Diagnostic Imaging (CBR) and the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO), in accordance with the American decision, suggest that verification should begin at 40.

The recommendations have been sharply criticized by some women’s health advocates, including Representative Rosa DeLauro, Democrat of Connecticut, and Representative Debbie Wasserman Schultz, Democrat of Florida, who say the advice does not cover all issues surrounding cancer screening.

In a letter sent to the task force in June, they stated that the guidelines continued to “fall short of the science, create coverage gaps, create uncertainty for women and their caregivers, and exacerbate health disparities.”

However, the task force suggested there was not enough evidence to endorse extra tests, such as ultrasounds or MRIs, for women with dense breast tissue. This means that health plans do not have to provide full coverage of additional screenings for these women, for whom cancer cannot be detected through mammograms alone and who are at greater risk of the disease to begin with. About half of all women aged 40 and over fall into this category.

September

In recent years, more mammography providers have been required by law to inform women when they have dense breast tissue and to tell them that mammography may be an insufficient screening tool for them. Starting in September, all mammography centers in the United States will be required to provide this information to patients.

The task force sets standards for which preventative care services must be covered by law by health insurers at no cost to patients.

Doctors often prescribe additional or “supplemental” tests for these people. But these patients often find that they have to pay for all or part of the series of tests themselves, even when those considered additional are carried out as part of preventive care, which, according to the law, should be provided free of charge.

Medicare, the government health plan for older Americans, for example, does not provide this type of coverage. In the private plan market, it is dispersed, depending on state laws, the type of plan and the plan’s design, among other factors.

“The panel’s decision not to support additional testing has significant implications for patients. What this means for coverage is that there is no mandate to cover these specific exams for women with dense breasts with zero-dollar cost-sharing,” says Robert Traynham, spokesman for AHIP, the association that represents health insurance companies. health.