By The Breast Cancer Action Team
On Tuesday, May 9 the U.S. Preventive Services Task Force (USPSTF) put forth a significant shift in their mammography screening guidelines, suggesting a decade-earlier date start for routine screening at age 40, rather than the age of 50 as outlined in previous guidelines.
According to Medscape, “Two major factors prompted the change, explained [USPSTF member John Wong, MD]. One is that more women are being diagnosed with breast cancer in their 40s. The other is that a growing body of evidence showing that Black women get breast cancer younger, are more likely to die of breast cancer, and would benefit from earlier screening.”
Breast Cancer Action holds two relevant stances with deep conviction:
Breast Cancer Action has long been critical of the potential harms from routine breast cancer screening, including over-diagnosis and over-treatment, and these harms may have disproportionate impacts on young womxn¹ and Black womxn, and especially for those who hold intersecting identities of being both young and Black.
This is due to the fact that mammography has reduced sensitivity in women² with high breast density.³ Given that breast tissue is likely to be denser prior to menopause⁴ and Black women are more likely to have dense breasts than their counterparts of other demographics,⁵ it could be argued that mammography screening is less likely to be effective for these groups.
So why is USPSTF recommending mammography for younger folx, and as a solution to breast cancer disparities? Because it’s all we have. Why is it all we have, after all these years?
We need to step back from the myopic view of mammography screening as the best and only tool in addressing breast cancer, and instead advocate for large-scale, structural public health changes.
BCAction has said this for years and we’ll say it again: mammography screening does not and cannot prevent or treat breast cancer. And too often results in over-diagnosis, and subsequent over-treatment, especially in younger people with dense breast tissue, and it is not good enough as our primary screening tool in the work to end breast cancer. To truly end breast cancer, we must focus on eliminating toxic exposures in our environment as a primary prevention strategy, while simultaneously improving our screening tools.
Organizations like USPSTF can and must join us in putting forth solutions beyond mammography screening.
Can we expect an organization that makes screening recommendations to think beyond mammography screening? Yes, as evidenced by their own recommendations, which begin to move toward advocating for more research and data.
There are some silver linings coming out of this seemingly-backwards recommendation.
We are able to hold this nuance that breast cancer screening tools MUST be improved, and this USPSTF change, including addressing disparities, can result in positive changes, like increased insurance coverage and more equitable research.
Dense breast tissue can make it more challenging to detect breast abnormalities on mammograms, as both dense tissue and cancerous masses appear white on the images, making it harder to differentiate between them. And breast density can vary within racial and ethnic groups, and within younger age groups, and individual variations exist regardless of racial or ethnic background. The increased prevalence of dense breast tissue in certain racial groups, particularly in Black folx, may contribute to the limitations of mammography as a screening tool in these groups, potentially leading to higher rates of false-negative results.
Recognizing the racial disparities and inequities in breast density can help inform healthcare providers and policymakers to consider alternative screening methods or patient-centered comprehensive strategies that may improve early detection in people with dense breasts, particularly in higher-risk groups.
It is crucial to consider breast density along with other risk factors and individual health profiles when developing personalized breast cancer screening plans. Yes, it’s positive that USPSTF is recognizing disparities and that they are calling for more research, but in the meantime, providers will continue to push more mammography for younger people and for BIPOC folx. Thus, this has to be an informed decision, made by the people working with their providers, because there are a number of concerning factors to take into account considering mammography.
These factors include, but are not limited to:
It may be too much for us to expect expansive, health justice solutions beyond mammography screening from an agency whose role it is to make mammography screening recommendations.
But herein lies exactly the problem and the solution: our long-term, comprehensive visioning for how to address and end breast cancer should not come from those with too-narrow a focus on screening instead of prevention, a priority of profit over public health, or conflicts of interest from within the Breast Cancer Industry.
We need unbiased, people-centered advocates in this work with justice-oriented visions and values, who can proffer systemic solutions. Join us in working to address and end breast cancer in this way, together.
¹ In this piece, BCAction uses “young women” to mean women under 50, or pre-menopausal women, given USPSTF’s addition of the age 40-49 demographic as now being recommended routine mammography screening.
² BCAction’s language preference is to use the more inclusive “womxn” over “women,” but when citing other data that uses the category of “women,” we do not alter the language.
³ Brunetti et al. (2022). A Prospective Comparative Evaluation of Handheld Ultrasound Examination (HHUS) or Automated Ultrasound Examination (ABVS) in Women with Dense Breast. Diagnostics (2075-4418), 12(9).
⁴ Several studies have found age to be a strong determinant of breast density. Dense breast tissue decreases as women get older. Compared to women who have gone through menopause, dense breasts are more common in younger women. Read more about breast density here: https://drsusanloveresearch.org/breast-cancer-explained/breast-density-2/