On April 30, 2024 the U.S. Preventive Services Task Force (USPSTF) published the final version of their recommendation on screening mammography guidelines and while not unexpected, the recommendations were even more disappointing than I expected. The wording while eloquent and very scientific sounding, seems to intentionally put American women at risk for breast cancer death by ignoring a decades long trend of decreasing mortality rates because of early detection with screening mammography.
Screening for late-stage cancers?It truly boggles my mind that they actually say it out loud that screening every-other-year (biennial) compared to every year (annual) is better because late-stage cancers can be seen with both practices! Based on this faulty reasoning alone the USPSTF should be disqualified from having any influence on policy or practice decision-making.
Read the guidelines in their own wording:
“Available evidence suggests that biennial screening has a more favorable trade-off of benefits versus harms than annual screening.”
“BCSC data showed no difference in detection of cancers stage IIB or higher and cancers with less favorable prognostic characteristics with annual versus biennial screening interval for any age group…”
“…and modeling data estimate that biennial screening has a more favorable balance of benefits to harms (eg, life-years gained or breast cancer deaths averted per false-positive result) compared with annual screening.”
Why is USPSTF abandoning early detection?
Breast cancers detected in the earlier stages of disease (0 and 1) have the best overall outcomes because they tend to be smaller, less likely to have lymph node involvement, more amenable to less invasive treatment and require less treatment for cure.
The USPSTF is not even looking at the same endpoint or goal that we in breast imaging are addressing.
Based on their assessments the (USPSTF) task force does not seem to support the premise of screening, much less that of imaging screening for breast cancer. And based on their own wording it is abundantly clear that early detection to save lives is not their aim.
Of course, there is no difference in mortality with later stage disease (IIB and higher). If you wait long enough cancers will eventually become evident clinically. This is not a screening concept! And the nebulous “harms” statement is just insulting to women as a basis for deferring a potentially lifesaving examination.
Patients and physicians need to advocate for breast health
Thus, I recommend that we (women and those of us working in the breast imaging industry) stop giving them the power to influence decision-making. They don’t care about your health or the health of your patients, so stop giving them the influence they currently garner. Their review of very selective data does not represent evidenced-based information.
Follow the guidelines of agencies that you know have stood the test of time and advocate unapologetically for women’s breast health (Society of Breast Imaging, American College of Radiology, American College of Obstetrics and Gynecology).
Please visit the websites listed below for evidenced based breast cancer screening guidelines for yourselves and your patients. Their lives depend on it.
“When someone shows you who they are, believe them the first time.” – Maya Angelou
U.S. Preventive Services Task Force, I believe you.
Connie Jones, M.D., Fellowship Trained, Breast Imaging Radiologist, Author of: “The Breast Test Book: A woman’s guide to mammography and beyond”
