Mammograms for the early detection of breast cancer must begin at age 40, be repeated every two years and continue until age 74, according to new recommendations approved by the Preventive Services Task Force of the United States (USPSTF, by its initials in English) and which were presented yesterday in the journal JAMA, published by the American Medical Association (AMA).
The new recommendations, which lower by ten years the age for starting mammograms recommended by the USPSTF, have been adopted due to the increase in breast cancer cases registered in the age group of 40 to 50 years . The decision is part of an international trend to expand the age range in which early detection of breast cancer is offered.
In Europe, the European Commission already recommends mammograms from 45 to 74 years of age, and to repeat them every two or three years. In Spain, only the Valencian Community, Galicia and Murcia are currently following the European recommendation.
The Spanish Society of Medical Oncology (SEOM) considers that “the European recommendations are the correct ones”, declared yesterday the oncologist César A. Rodríguez, president of the entity. “It cannot be said at the moment that the benefits of screening in the 40 to 44 age group are well established. In the group from 45 to 49 they are.”
The majority of communities – including Catalonia and Madrid – currently limit the early detection of breast cancer through public health to the 50 to 69-year-old age group. Four other communities (Castilla-La Mancha, Castile and León, La Rioja and Navarre) have extended the starting age to 45, but still do not offer it to the 70 to 74-year-old group, in which the incidence of breast cancer is higher.
In Catalonia, “the suggestion of expanding” the screening ages made by the European Commission is being evaluated, a spokesman for the Department of Health has informed.
“It is a complex subject in which risks and benefits must be assessed,” declares Montserrat Muñoz, coordinator of the breast cancer unit at the Clínic hospital. “There are fewer people affected in the 40 to 50 age group than in the 50 to 69 age group”, which is why “it is necessary to do many mammograms on women who will not have pathology to detect a small number of cancers”.
The United States USPSTF assessed that “the incidence [of breast cancer] in women aged 40 to 49 increased gradually between 2000 and 2015” and that it “increased most notably between 2015 and 2019, with an average annual increase of 2.0%”, according to the report in which it presents the new recommendations.
There is no data on the possible increase in breast cancer cases in women under 50 in Spain.
The new USPSTF recommendations update the previous ones, published in 2016, and are based on a review of the currently available scientific evidence on mammography and epidemiological trends in breast cancer.
The recommendations are aimed at cis women at average risk of breast cancer, as well as trans men and non-binary people born anatomically female. They are not applicable to people at high risk of breast cancer (for example, for hereditary reasons or having been exposed to high doses of radiation to the chest), for whom the early detection strategy must be assessed on an individual basis .
The expert group recommends repeating mammograms every two years, rather than every year, because in this way the number of false positives is reduced and the ability to detect incipient tumors is maintained, when the prospects of successfully treating them are high False positives – that is, the detection of a possible cancer which later turns out not to be – require additional diagnostic tests and usually have a negative psychological impact on the women affected.
The USPSTF estimates that performing biennial mammograms from ages 50 to 74 prevents 6.7 breast cancer deaths for every 1,000 women (which equates to saving one in 149 women). If screening starts at age 45, 7.5 deaths are avoided for every thousand women (one in 133). If you advance to 40, 8.2 are avoided for every thousand (one in 122).
“The incidence of breast cancer increases with age and reaches its highest point between the ages of 70 and 74,” points out the USPSTF. In this age group, to which only a minority of communities in Spain offer breast cancer screening, biennial mammograms reduce breast cancer mortality by 22%.
Over the age of 75, the USPSTF refrains from recommending that mammograms continue to be performed because studies have not been done to assess whether the benefits outweigh the risks in this group.
The new recommendations are part of “a trend to reduce the age at which mammograms start; it is a decision that requires an adequate allocation of resources so that screening reaches the entire target population and that here in Catalonia is being evaluated”, points out Cristina Saura, breast cancer specialist at the Vall d’Hebron hospital and the Vall d’Hebron Oncology Institute (VHIO).
Looking to the future, adds Saura, “we will evolve towards greater personalization of breast cancer screening programs, taking into account each person’s individual risk and incorporating new imaging and artificial intelligence technologies “.
