In an update to its 2002 recommendations, the U.S. Preventive Services Task Force (USPSTF) now recommends against routine breast cancer screening for women under the age of 50. The recommendations, which appeared in the Annals of Internal Medicine on November 17, 2009, apply only to women 40 years or older who are not at increased risk for breast cancer due to a known underlying genetic mutation or a history of chest radiation.
In addition to revising the age at which mammography screening should begin, the USPSTF also suggests changing the screening interval from 1 year to 2, up to the age of 74. There is insufficient evidence to determine the screening benefits and harms for women aged 75 or older. The updated guidelines conflict with advice from groups such as the American Cancer Society and the American College of Radiology, which continue to recommend annual mammograms starting at age 40.
The Task Force recommends against teaching breast self-examination (BSE), as adequate evidence suggests that teaching BSE does not reduce breast cancer mortality. USPSTF researchers also conclude that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) for women 40 years of age or older. This recommendation is a change from the 2002 statement, which suggested mammography screening, with or without clinical breast examination, every 1 to 2 years for women 40 years of age or older.
The USPSTF did not recommend one form of mammography over another. According to its recommendation, the current evidence is insufficient to assess additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer.
To update the 2002 recommendation statement, researchers systematically reviewed the published evidence of the efficacy of five screening modalities in reducing mortality from breast cancer: film mammography, CBE, BSE, digital mammography, and MRI. In addition, the Task Force commissioned two studies related to breast cancer screening, one of which used population modeling techniques to compare the expected health outcomes and resource requirements of starting and ending mammography screening at different ages and using annual versus biennial screening intervals.
The recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality (AHRQ) or the U.S. Department of Health and Human Services (HHS).