In 2009, the U.S. Preventive Services Task Force (USPSTF) made controversial changes to breast cancer screening guidelines, recommending less frequent mammograms for women under 50. This shift raised concerns about potential increases in late-stage breast cancer diagnoses and more invasive surgical treatments. Despite concerns that the USPSTF guideline changes might lead to more advanced cancers, data from a recent study published in JAMA Network Open suggests a different story.
Researchers at the University of Vermont analyzed over 2 million breast cancer diagnoses from 2004 to 2019 and found that while in situ (non-invasive) breast cancer rates have decreased since 2009, the likelihood of diagnosing breast cancer cases at advanced stages also declined. These findings suggest the reduced screening frequency has not led to a significant increase in more advanced cancers at diagnosis.
The study also examined trends in surgical treatments and found that the proportion of cases treated with partial mastectomy (lumpectomy) initially decreased but has been increasing since 2012. Total mastectomies with reconstruction saw a rise followed by a decline in recent years. These trends indicate that less invasive surgical options remain prevalent despite changes in screening practices.
Why this matters
These findings allow journalists to provide nuanced reporting on breast cancer screening and treatment. It can be challenging for the public to grasp the concept that less frequent screenings is not necessarily a negative thing, especially when a large number of stories on breast cancer detection focus on the message of getting screened. Still, it’s important to communicate that while screening rates have decreased, this has not translated into a clear increase in advanced cancers or more aggressive treatments. Instead, we should emphasize the complexity of the issue, and avoid alarmist headlines that might oversimplify the relationship between screening frequency and cancer outcomes.
In 2009, the USPSTF advised biennial (every other year) mammography for women ages 50 to 74. For women ages 40 to 49, the USPSTF recommended individualized decision-making, suggesting that starting regular screening before age 50 should be based on personal values regarding specific benefits and harms.
The rationale behind the 2009 guideline was to reduce psychological distress, false positive results and overdiagnosis. It’s also important to note that these guidelines are for women at average risk and that individual risk factors may warrant different screening approaches.
In 2024, the USPSTF revised its guidelines, recommending that all women begin breast cancer screening at age 40 and continue screenings once every other year through age 74. This change reflects new evidence of increased incidence of breast cancer in younger people, indicating that starting screenings at age 40 can save more lives by detecting breast cancer earlier.
Contextualize research
When reporting on breast cancer risk, it’s also important to contextualize research findings within broader trends. For example, the study noted a long-standing increase in localized invasive breast cancer over the past 20 years, which warrants further investigation. This trend, however, shouldn’t necessarily be linked to reduced screening frequency. Instead, this trend may highlight the need for balanced reporting that acknowledges the benefits of early detection and the potential drawbacks of overscreening, such as false positives and overdiagnosis.
Consider encouraging readers to have informed discussions with their health care providers about their risk factors and screening needs. Emphasizing shared decision-making between patients and doctors can help women make choices that align with their values and circumstances.
