Annual Breast Cancer Screening Starting at Age 40 Best, Modeling Study Says

Annual breast cancer screening at ages 40 to 79 resulted in the greatest reduction in mortality, according to a study comparing various screening scenarios.

Using Cancer Intervention and Surveillance Modeling Network (CISNET) estimates of breast cancer screening outcomes published in 2009, 2016, and 2023, mortality was reduced by 41.7% with annual screening starting at age 40 and continuing up to age 79, reported Debra L. Monticciolo, MD, of Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, and colleagues.

This was in comparison with biennial screening at ages 50-74, which reduced mortality by 25.4%; biennial screening at ages 40-74, which reduced mortality by 30%; and annual screening at ages 40-74, which reduced mortality by 37%, they noted in Radiology.

Annual screening at ages 40-79 also averted the most breast cancer deaths (11.5 per 1,000 screened), and gained the most life-years (230 per 1,000 screened) versus the other screening scenarios (range 6.7-10.3 per 1,000 and 121-217 per 1,000, respectively).

And while false-positive screening results and benign biopsies were highest with annual screening at ages 40-79, “these risks are lowest on a per-examination basis with this scenario, suggesting that these risks are manageable,” Monticciolo and team wrote.

Changing the newest U.S. Preventive Services Task Force (USPSTF) draft recommendation of biennial screening from ages 40-74 to annual screening up to age 79 “would markedly improve mortality reduction for all U.S. women,” they concluded.

“The goal of any cancer screening program is to avert untimely cancer deaths,” they added. “Thus, annual breast cancer screening starting at 40 years of age and extending to 79 years of age and beyond is the best way to achieve that goal.”

In an accompanying editorial, Bonnie N. Joe, MD, PhD, of the University of California San Francisco, noted that “it is disappointing that the USPSTF did not come out in full support of annual screening, particularly if their goal is to reduce healthcare disparities.”

Despite evidence like the results from this study, “the USPSTF stuck with a biennial screening interval,” she wrote. “This seems counter to the goal of reducing healthcare disparities, particularly because the USPSTF highlights concern about more aggressive cancers in younger persons and in Black persons.”

As for the estimates for Black women, Monticciolo and colleagues determined that annual screening up to 79 years of age showed the highest breast cancer mortality reduction, breast cancer deaths averted, and life-years gained.

Based on 2023 CISNET estimates for digital breast tomosynthesis, mortality reduction in Black women was 39.6% with annual screening at ages 40-79, compared with 24.1% with biennial screening at ages 50-74 and 29.9% with biennial screening at ages 40-74.

Moreover, the number of breast cancer deaths averted and life-years gained would be 42% higher for Black women than for non-Black women with annual screening at ages 40-79 years.

For this study, the researchers assessed four different screening scenarios: biennial screening at ages 50-74 (the 2009 and 2016 USPSTF recommendations), biennial screening at ages 40-74 (2023 USPSTF draft recommendation), annual screening at ages 40-74, and annual screening at ages 40-79.

The authors noted that their study had limitations. For example, CISNET model estimates for 2016 only went to age 74 and 2023 estimates only went to age 79. Therefore, they said they could only approximate the current American College of Radiology, Society of Breast Imaging, and National Comprehensive Cancer Network recommendations of annual screening starting at age 40 and extending beyond age 79.

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