The New England Journal of MedicineThe New USPSTF Mammography Recommendations — A Dissenting View

USPSTF’s Lowered Mammography Age Recommendation Raises Ethical and Efficacy Questions

In a significant move, the US Preventive Services Task Force (USPSTF) has revised its age recommendation for mammography screenings, lowering it from 50 to 40 years. The decision impacts more than 20 million US women and has potential implications for primary care practitioners who may now need to comply with this new guideline. This article scrutinizes the Task Force’s data and modeling techniques, questioning both the ethical and scientific bases for the revised recommendation.

HCN Medical Memo
The recent change in mammography screening guidelines poses a dilemma for healthcare providers. The USPSTF’s new recommendation may not offer substantial benefits, given the low absolute risks and the potential for harm, including false positives and overtreatment. For physicians, it’s crucial to engage in a more nuanced discussion with patients about the true pros and cons of mammography screening, rather than blindly adopting new guidelines based on flawed statistical modeling.

Key Points

• The USPSTF’s new recommendation changes the mammography screening start age from 50 to 40 years, affecting more than 20 million U.S. women.
• No new evidence supports that mammography benefits have increased for women in their 40s. Existing randomized trials show no significant effects.
• Breast-cancer mortality has decreased significantly in the United States, particularly among women under 50, but these reductions are largely attributed to improved treatment, not screening.
• The recommendation relies heavily on statistical models which are questionable in their assumptions, including an overestimation of mammography’s effect on breast-cancer mortality.
• Physicians and experts argue that statistical models are not sufficient for such a critical public health decision.

Breast-cancer mortality in the US has decreased significantly, particularly among women under 50, with a reduction by half over the past 30 years according to the National Vital Statistics System.

Additional Points

• There is a low absolute risk of breast-cancer death for women in their 40s—screening only improves the likelihood of not dying from 99.7% to 99.8% over a 10-year period.
• Potential harms include a 36% likelihood of false alarms and subsequent additional testing and costs.
• The new guidelines do not effectively address disparities in breast-cancer mortality rates between Black and White women.

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