ACOG updates breast cancer screening recommendations

The American College of Obstetricians and Gynecologists (ACOG) has updated its breast cancer screening recommendations, recommending that people at average risk for breast cancer begin mammography screening at age 40 .

This redesign reflects evolving evidence that starting earlier screening results in greater net benefits in reducing breast cancer mortality, particularly for certain ethnic groups with higher risk factors.

Breast cancer is the second leading cause of cancer death among American women overall and the leading cause of cancer death among African American and Hispanic women.

Although mammography has long been recognized as a life-saving tool by detecting cancer early, the question of when screening should begin has been debated, due to concerns about overdiagnosis, false positives and potential harms such as unnecessary biopsies.

Recent evidence-based data has prompted ACOG to revise its recommendations for people assigned female at birth, including cisgender women, transgender men, and nonbinary people.

These updated recommendations include people with dense breast tissue or a family history of breast cancer, but exclude those with higher risk factors, such as a personal history of breast cancer or a history of high-density lesions. risk during breast biopsy, genetic mutations associated with higher cancer risk, or a history of high-dose thoracic radiation therapy at a young age.

According to the new recommendations, routine screening mammography should begin at age 40 and can be performed annually or every 2 years, based on an informed and shared decision-making process that takes into account the benefits and harms potential of frequent screening.

Previously, ACOG recommended starting screening between ages 40 and 50, based on individual risk factors and preferences, with screening required by age 50 at the latest. However, several factors, including the increasing incidence of breast cancer among younger women, influenced the decision to lower the recommended age of care.

Increased incidence in younger women

Between 2015 and 2019, the incidence of invasive breast cancer among women aged 40 to 49 increased by approximately 2% per year.

“The trend of increasing breast cancer diagnoses among women aged 40 is concerning, and new data shows that earlier detection could make a significant difference in reducing deaths from breast cancer,” said Dr. Eve ZaritskyFACOG, co-author of the clinical practice update.

“Although screening can sometimes cause people anxiety and even unnecessary follow-up, the benefits of early breast cancer diagnosis outweigh these risks sufficiently to justify performing mammograms at the age of 40 years old. »

Studies sponsored by the US Preventive Services Task Force (USPSTF) show that starting mammograms at age 40 provides greater overall benefit than starting at age 50. Early detection reduces deaths from breast cancer and increases years of life gained when compared to the harms of false positives, overdiagnosis and innocuous biopsies.

Fighting health inequalities

The benefits of early detection should be particularly significant for African or African-American women, who have disproportionately high breast cancer mortality rates. Although the overall incidence of breast cancer is lower among black women than white women, they have a 40% higher 5-year age-adjusted mortality rate and a 45% increased incidence of cancer. invasive breast cancer before the age of 50.

Black women are also more likely to be diagnosed with aggressive subtypes, such as triple negative breast cancer, which is harder to detect and treat and occurs at younger ages.

Racial disparities in breast cancer outcomes are deeply rooted in inequalities in social determinants of health, such as access to care, housing, and environmental conditions. African-American women are also less likely to receive comprehensive or timely treatment than leucoderma women, contributing to lower survival rates, even after adjusting for socioeconomic factors and insurance status.

“Our updated recommendation addresses significant inequities in breast cancer diagnosis, treatment and death, and we hope that early initiation of mammography screening at all levels will have a net beneficial effect in terms of outcomes for Black women in particular, who have been found to have the most adverse outcomes with respect to breast cancer, in part due to long-standing inequities in the social determinants of health,” added the co- author Cherie C. Hilldoctor of medicine, FACOG.

ACOG’s updated recommendation aligns with other leading organizations, including the USPSTF, the National Comprehensive Cancer Network, the American College of Radiology, and the Society of Breast Imaging. This growing consensus among experts is expected to reduce confusion among doctors and patients about when to begin screening, thereby improving screening rates among individuals in the 40 to 49 age group.

This article was translated from Medscape.com part of the Medscape professional network, using several editorial tools, including AI, in the process. The content was reviewed by the editorial staff before publication.