Breast cancer remains a significant public health concern, affecting millions of women worldwide. The first half of 2023 has witnessed crucial policy developments in breast cancer screening, offering hope to save countless lives and address glaring disparities. However, as we take steps forward, it is essential to acknowledge the missteps that require deliberate action and bipartisan leadership from Congress. In particular, the proposed breast cancer screening guidelines released by the US Preventive Services Task Force (USPSTF) in May 2023 have generated both commendation and concerns. Let's delve deeper into the importance of clear and inclusive breast cancer screening guidelines.
Guidelines That Miss the Mark:
The USPSTF's proposed guidelines mark their first update since 2009, aiming to improve breast cancer screening practices. While the recommendation to start mammography at age 40 for women at average risk is a laudable adjustment, it falls short in certain critical areas. First, the guidelines do not emphasize the need for annual mammograms, despite other medical associations consistently recommending yearly screenings. The USPSTF's own modeling reveals that annual screening can reduce breast cancer deaths by 42 percent, compared to a 24 percent reduction with biennial screening. By not recommending annual mammograms, the guidelines miss an opportunity to maximize the early detection of breast cancer.
Breast cancer does not impact all communities equally, and it is crucial to address the disparities that exist. Sadly, Black women are 40 percent more likely to die from breast cancer compared to their white counterparts, despite having a lower incidence rate. The proposed USPSTF guidelines missed the opportunity to address the increased risk faced by Black women and other ethnic groups adequately. In contrast, the American College of Radiology recently recommended earlier risk assessment for high-risk groups such as Black and Ashkenazi Jewish women, with consideration for mammography before the age of 40. By failing to address these disparities and provide tailored recommendations, the proposed guidelines fall short of the necessary inclusivity.
Additional Screening Considerations:
Another aspect where the proposed guidelines missed the mark is regarding additional screening for women with dense breasts. Breast density has been associated with an increased risk of breast cancer, particularly the aggressive triple-negative subtype that disproportionately affects Black women. Unfortunately, mammograms alone may miss up to 50 percent of cancers in dense breast tissue. However, multiple published studies have demonstrated that combining mammography with other screening tests such as ultrasound or MRI significantly improves cancer detection in women with dense breasts. While the USPSTF acknowledges the importance of breast density, they do not recommend additional screening, citing limited evidence. This omission undermines the opportunity to detect breast cancer at its earliest and most treatable stages.
The importance of clear and inclusive breast cancer screening guidelines cannot be overstated. The USPSTF's proposed guidelines represent a step forward by acknowledging the need to lower the age for mammography initiation. However, they fall short in terms of frequency, risk assessment for Black women, and additional screening for women with dense breasts. To ensure effective and equitable breast cancer screening, it is imperative that the USPSTF revisits and adjusts their guidelines to address the needs of all women, particularly those at higher risk. In parallel, Congress must take swift action to remove excessive out-of-pocket costs for diagnostic screening. By doing so, we can save thousands of lives and work towards eliminating the disparities that continue to plague breast cancer outcomes. Together, let us advocate for clear guidelines, accessible screening, and equitable care, thus making a tangible difference in the lives of women facing breast cancer.
PBH provides screening and/or diagnostic mammograms, ultrasounds, and biopsies at no cost for medically uninsured women aged 40 and over whose income is no more than 400 percent of the federal poverty level. Other individuals may qualify with a physician’s referral. PBH partners with Haven Health Clinic for clinical breast exams and physician’s referrals. PBH contracts with BSA Harrington Breast Center for screening services. Ask them about their Mobile Mammography availability.