USPSTF’s Proposed Breast Cancer Screening Guidelines

| | May 16, 2023

USPSTF Screening Recommendations website screen shot

USPSTF’s Proposed Breast Cancer Screening Guidelines prompt comments from UCSF Breast Imaging faculty Bonnie Joe, MD, PhD, and Kimberly Ray, MD 

On May 9, the U.S. Preventive Services Task Force (USPSTF) proposed a significant change to current breast cancer screening guidelines. The USPSTF’s draft proposal recommends lowering the recommended breast cancer screening age for average risk women to 40. Current USPSTF guidelines, in place since 2016, recommend starting biennial screening by age 50. 

The new recommendations are a positive step, but don’t go far enough, according to Bonnie Joe, MD, PhD, professor and chief of Breast Imaging at UCSF. “The goal of breast cancer screening is to reduce breast cancer deaths and morbidity -- the adverse impact of the disease on the person. We should stick to that goal, and annual screening -- not biennial – is the best way to meet this goal for those at average risk.” 

A concern, says Dr. Joe, is the fact that USPSTF recommendations are tied to insurance coverage under the Affordable Care Act. Under the proposed guidelines, many people who want to be screened annually may lose coverage for yearly exams. “Those with more resources will still be able to afford to be screened every year while those with fewer resources may be screened less frequently, increasing their chance of their cancers not being diagnosed until they are at a more advanced stage.”

The draft also noted that beginning mammography screening at a younger age and screening more frequently may increase the risk for overdiagnosis (OD) and subsequent overtreatment. “Interval has no effect on OD,” counters Dr. Joe. “Tumors don’t go away, so a truly over-diagnosed cancer will still be there at the next mammogram – no matter whether it is one year or two years between exams.”