Many women understand that screening for breast cancer – the most common cancer among women – is a key way to find the cancer early and reduce your chances of dying from it.
But the details of when to start and how often to be screened have been heavily debated in recent decades as various organizations recommend different ages and intervals.
Recently, the United States Preventive Task Force (USPSTF) released new draft guidelines about mammography, sparking many news stories – and new questions.
What’s the bottom line women should know? We asked Avice O’Connell, MD, professor of Imaging Sciences and a breast screening expert with UR Medicine Breast Imaging. The details are below, with light editing for clarity and brevity.
Can you summarize what the new USPSTF draft guidelines said, or what stands out to you most prominently from these guidelines?
Very simple: start screening at age 40 if you’re average risk. We feel like it’s a start, to tell people to come at 40, not 50, but we feel like these new guidelines didn’t go quite far enough. The next question is, how often should you get screened? And that’s where we diverge.
The American College of Radiology (ACR), the Society of Breast Imaging (SBI), and the National Comprehensive Cancer Network (NCCN) all say you need to come every year. These draft guidelines from the USPSTF suggest every other year.
As the USPSTF requested feedback on their newly drafted guidelines, a lot of us wrote in to say, please consider recommending screening every year. There is a lot of evidence to support every year. Hopefully by the time the USPSTF writes the final recommendation, it will recommend screening every year.
Once women start screening, why should they do it annually?
When people have an aggressive cancer, it can show up in that middle year. So, if you go every two years, you might get away with it, but if you’re unlucky and you have a fast-growing cancer, it can do a lot of damage in two years.
So, we feel like, what’s the downside? It’s uncomfortable. We might call you back to get more views. But most of the time, you do it, there is nothing there, and it’s a good feeling. If you wait two years, we can’t promise. A lot of things can happen in two years.
What is the most important takeaway for women with this news?
The most important take away is, if you’re average risk, start screening at age 40 and not at 50.
What is average risk? That will be somebody who has not got a strong family history. Average risk is most people.
What is high risk? With the new risk calculations we use, there are a lot of factors we can add into determining an individual’s risk, things like entire family history, other cancers that may be associated with breast cancer, and breast density.
Women who have very dense breasts should add in an ultrasound. If they’re at high risk, they should add in an MRI. If anyone has a question about their cancer family history and risk of breast cancer, please consider seeing a specialist. Wilmot Cancer Institute’s Breast Health Program helps guide patients with a concern when it comes to breast cancer risk, whether genetic or otherwise.
Does insurance cover women getting screened annually at age 40? What should you do if you need to be screened but don’t have insurance?
Yes, your mammogram, right now today, is covered every year. We’re afraid that might be taken away. Since 2009 and the Affordable Care Act, one mammogram a year from age 40 for the rest of your life, no questions asked, is covered by insurance, with no cost sharing. That’s now.
What the new USPSTF guidelines are dangerously close to is, if the insurance companies choose to use the USPSTF guidelines for what they pay for, they may choose not to pay for every other year when you’re 40, and then they may stop paying at age 74. Their guidelines could limit what we currently have now.
In May 2023, a bill was reintroduced called the “Find It Early Act.” It has bipartisan support, and was announced along with award-winning journalist Katie Couric. It would ensure all the supplemental screening is covered as well, but it may be a long way to go before it could become a law.
Right now, if I find that somebody’s dense and needs an ultrasound, is it covered by insurance? That’s not an easy answer. You might be charged whatever your copay or deductible is. There are some insurance companies that will cover it if the indication is dense breasts. But people really have to check with their insurance to find out what they cover.
If you don’t have insurance, there are resources to help, such as Cancer Services Program of the Finger Lakes. They help residents in Monroe, Livingston, Wayne, Ontario, Seneca, and Yates counties get breast cancer screenings at no cost. They can be reached at (585) 224-3070.
What advice would you have for women who struggle to remember to get their annual mammogram?
Well, one tip is, once you are eligible for your mammogram, you can schedule your own appointment through MyChart, rather than having to call in to make an appointment. That means, as you’re at home and at 11 at night, it hits you that you need to book your mammogram, you can go on your phone or on your computer right then and book. It’s extremely easy and helpful for busy women.
Once you book it, even if you’ve had previous mammograms someplace else, you don’t have to do anything. We do all of that electronically. But if you have questions, you can call us at (585) 487-3300.