Question 1

Why were the mammogram guidelines changed?

Accepted Answer

Cancer rates among younger Americans are on the rise. And more women in their 40s are getting breast cancer, with the number of newly diagnosed women increasing about 2 percent each year, said John Wong, an internist and professor of medicine at Tufts University School of Medicine, who is a vice chair on the task force. Black women are more likely than White women to be diagnosed with breast cancer at a younger age and more likely to be diagnosed with an aggressive form called triple-negative breast cancer. They are also about 40 percent more likely to die of breast cancer than White women, research shows. Overall, more than 42,000 women die of breast cancer each year in the United States, data shows. The task force proposed the new guidelines last year to address the rising breast cancer rates among younger women and also mitigate racial disparities, and has now formally approved the advice. “It could potentially save as many as 1 in 5 women, or 20 percent, from dying from breast cancer,” Wong said.

Question 2

Why aren’t older women advised to get screened?

Accepted Answer

The task force concluded there wasn’t enough evidence to assess the benefits vs. harms for screening mammograms for women older than 74. Potential harms include false positives that may take a psychological toll and lead to unnecessary follow-up tests and procedures, as well as the added — yet minimal — radiation exposure, the task force noted.

Question 3

What are the screening recommendations for women with dense breasts?

Accepted Answer

Guidance for women with dense breasts was also inconclusive in some ways. While all women are encouraged to start screening mammograms at age 4o, mammograms may not be as effective for women with dense breasts, who make up nearly half of women 40 and older who get screened, research shows. The task force did not find enough evidence for supplemental screenings such as ultrasounds or MRIs for women with dense breasts. Women at high risk of developing breast cancer — including those who have a genetic marker or syndrome associated with a high risk of breast cancer such as BRCA1 or BRCA2 genetic variation — are not covered by the new task force recommendations. In 2019, the task force advised that primary care providers assess women who are considered high risk and, when indicated, prescribe genetic counseling and then, if needed, genetic testing. In these cases, private insurers and state Medicaid expansion programs are required to cover the cost for the counseling and testing.

Question 4

Will the new guidelines change insurance coverage for mammograms?

Accepted Answer

Most insured women in the United States are already covered for annual screening mammograms without cost-sharing starting at age 40 based on existing guidelines from independent medical and scientific recommending bodies. “The task force recommendation is not going to change what insurance plans are required to cover,” as far as mammograms are concerned, said Alina Salganicoff, a senior vice president and director of the Women’s Health Policy Program at KFF, formerly the Kaiser Family Foundation. Women with employer-based insurance and private insurance, which include nearly 70 percent of women ages 19 to 64, are covered starting at age 40 at least biennially but as frequently as annually through at least age 74, though “age alone should not be the basis to discontinue screening,” according to guidelines from the Health Resources and Services Administration. Women who qualify for Medicaid expansion are subject to the same coverage rules as the private insurance plans. For women who are not part of the expansion program, the scope of coverage is up to the states. Medicare, which has its own rules but considers recommendations from the task force, covers screening mammograms once a year for women 40 and older, with a one-time baseline screening between ages 35 and 39. “We think of our recommendations as more of a floor than a ceiling,” Wong said, noting that lawmakers, regulators and insurers can make their own coverage decisions. “We do seek to inform clinicians, but we also seek to inform the public and people who are thinking about decisions to help themselves live longer and better lives.”

Question 5

Why do different medical groups give different advice?

Accepted Answer

William Dahut, chief scientific officer of the American Cancer Society (ACS), said he thinks the task force is “moving in the right direction” by lowering the age for screening mammograms to 40. But the task force guidelines still differ from other recommendations. The ACS, for instance, recommends that all women at average risk of breast cancer start annual screening mammograms, not biennial screenings, by age 45 and continue annual screenings at least to age 54. Starting at age 40, women can consider speaking with their medical provider about starting annual screenings, and those 55 or older can consider switching to biennial screenings. Unlike the task force guidelines, the ACS does not put an age limit on screenings, stating that women should continue as long as they are healthy and expected to live at least 10 more years. The American College of Radiology and Society of Breast Imaging recommend that women at average risk start at age 40, but by 25, all women should talk to their doctors about their individual risk factors to determine whether earlier screening may be needed for them. The American College of Obstetricians and Gynecologists (ACOG) recommends mammograms every one to two years beginning at age 40 for patients at average risk of breast cancer. After age 55, it is “reasonable” to reduce screening to every two years “to reduce the frequency of harms, as long as patient counseling includes a discussion that with decreased screening comes some reduction in benefits,” according to ACOG. “The good news is, every major national guideline in the United States is now recommending that women at average risk of breast cancer should be offered screening or recommended to have screening starting at age 40,” said Mark Pearlman, professor emeritus at University of Michigan Health System and senior author of ACOG’s most recent practice bulletin on breast cancer screening.

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