A major public health agency last week expanded its breast cancer screening guidelines to include younger women — but some people are concerned that one key age group has been excluded.
The U.S. Preventive Services Task Force (USPSTF) announced on April 30 that women between ages 40 and 74 should get mammograms every other year.
This is a significant change from previous guidelines, which said women should begin biennial mammograms at age 50, but could opt to begin as young as 40.
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Some experts object to the fact that the agency doesn’t include official screening recommendations for women older than 74.
“The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women 75 years or older,” the agency stated in the guidance.
The U.S. Preventive Services Task Force (USPSTF) announced on April 30 that women between the ages of 40 and 74 should get mammograms every other year. (iStock)
Dr. Denise Pate, medical director with Medical Offices of Manhattan and contributor to LabFinder, voiced her disagreement with the lack of mammogram recommendations for older women.
“I think it is an antiquated view that sells short the potential of women older than 75,” she told Fox News Digital.
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“The recommendations consider that the older population may be over-diagnosed, potentially with slow-growing breast cancers — but this does not take into account the increase in life expectancy for American women.”
A woman who is 75 right now has a life expectancy of 87, according to the U.S. Centers for Disease Control and Prevention (CDC).
Lack of research
One of the main reasons that women over 74 were excluded is that the age group was not included in clinical trials.
“When the major randomized controlled trials were performed in the 1970s and 1980s to show how effective mammograms are, they didn’t include enough women in those age groups to confirm their necessity,” Dr. Jacqueline Holt, medical director of women’s imaging for national radiology provider RadNet in Wilmington, Delaware, told Fox News Digital.
One of the main reasons that women over age 74 were excluded is that the age group was not included in clinical trials. (iStock)
“Cancer risk doesn’t drop off at 74 — the risk increases,” she said.
“It’s misinformation that cancers grow slower in this age group and that women will die of something else first.”
Risks vs. benefits
The primary risk noted for screening older women is the potential for false positives.
“The potential harms of breast cancer screening in older women include false positive results and overdiagnosis,” said one study published in the Journal of the American Board of Family Medicine.
“Cancer risk doesn’t drop off at 74 — the risk increases.”
Among women 75 years and older, 200 out of 1,000 who are screened over a 10-year period will experience a “false alarm,” the researchers noted, “which can cause pain, anxiety and distress.”
Pate acknowledged that this risk does exist.
“Of course, with continued screening, there is the continued risk of finding breast cancer in an earlier stage or finding a suspicious image that prompts recommendations for biopsy, proving to be a false positive — and this can cause a lot of anxiety,” she said.
The risks of not screening are “leaving these women in the dark about their status,” a doctor said. (iStock)
The risks of not screening, however, are “leaving these women in the dark about their status,” the doctor said.
“As I always explain to my patients, knowledge is power,” Pate told Fox News Digital.
“I would rather choose anxiety about a biopsy that may or may not prove breast cancer versus anxiety of surgery, radiation and chemotherapy for a cancer that is found too late due to lack of screening.”
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Holt agrees the benefits outweigh the risks.
“The primary risk that the USTF focuses on is anxiety due to false positives or callbacks that don’t lead to a diagnosis of cancer,” she told Fox News Digital.
“The death rate has decreased by at least 40% since 1995, thanks to mammographic screenings finding the cancer earlier and better treatment.”
“The death rate has decreased by at least 40% since 1995, thanks to mammographic screenings finding the cancer earlier and better treatment,” a doctor said. (iStock)
Women do have the option to continue screening beyond the age of 74 if they choose, the doctors noted — and this should be covered by their insurance plan.
“There is no cut-off for age,” Holt noted. “Medicare will still cover the cost of a mammogram.”
The American College of Obstetricians and Gynecologists (ACOG), the American Cancer Society (ACS) and the National Comprehensive Cancer Network (NCCN) all recommend mammograms starting at age 40.
“Age alone should not be the basis to continue or discontinue screening.”
“Each of these three groups bases its stop age on a woman’s life expectancy and not simply on their age,” Pate noted.
The ACS has stated that women should continue receiving mammograms as long as they are in overall good health and expect to live for another 10 years or more.
More than one-quarter of cases of breast cancer are diagnosed in women 75 years and older, according to ACOG.
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“Age alone should not be the basis to continue or discontinue screening,” according to a statement from ACOG.
“Beyond age 75 years, the decision to discontinue screening mammography should be based on a shared decision-making process informed by the woman’s health status and longevity.”
More than one-quarter of cases of breast cancer are diagnosed in women 75 years and older, according to the American College of Obstetricians and Gynecologists. (iStock)
Dr. Wanda Nicholson, chair of the USPSTF, sent a statement to Fox News Digital about the decision to omit women over age 74 in the recommendations.
“Women deserve to know what the science says about how they can best stay healthy as they age,” she said.
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“We looked carefully at all the available evidence about whether women who are 75 and older should be screened for breast cancer, but unfortunately, the available research was limited.”
“Women deserve to know what the science says about how they can best stay healthy as they age,” a doctor said. (iStock)
“None of the studies of breast cancer screening included women in this age group, so we are urgently calling for more evidence on this important population.”
She added, “In the meantime, we encourage women who are 75 and older to talk with a trusted health care professional about what preventive care is right for them, given their specific health circumstances.”
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Fox News Digital reached out to the ACOG and the ACS requesting additional comment.
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