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The U.S. Preventive Services Task Force—a volunteer panel of national experts in prevention and evidence-based medicine that makes recommendations for clinical preventive services such as screenings, counseling services, or medications—has generally been considered an honest broker, willing to buck political and popular pressures to give advice consistent with the available evidence. New USPSTF draft recommendations on breast-cancer screening suggest that this may have changed.
When the USPSTF last updated its breast-cancer screening recommendations about eight years ago, it found that, for women under 50 with an average risk of cancer, the harms of screening outweighed the benefits. It recommended routine screening for women 50 or older and advised younger women to consult with their physicians to discuss whether their history and individual risk factors warrant screening.
This recommendation echoed guidelines used around the world. The U.K, France, Denmark, and Germany, for example, screen women 50 and older, but there is no organized screening of women in their forties. Switzerland has no screening program for women of any age.
The USPSTF recently issued a draft recommendation lowering the starting age for mammography screening from 50 to 40 years. This will affect approximately 20 million additional women. It is not clear what prompted the change.
The USPSTF acknowledged that no new randomized trials of screening mammography for women in their forties have been conducted since the previous recommendation was made. Nor have new, follow-up findings emerged from the eight previous randomized trials in this age group, all of which found no significant benefit.
Instead, the task force relied on modeling studies to provide information about the benefits and harms of breast-cancer screening in different age groups. As with any model, the results depend on the assumptions made. The model assumed that screening mammography reduces breast-cancer mortality by 25 percent and concluded that lowering the starting age from 50 to 40 would result in 1.3 fewer deaths over a lifetime for every 1,000 women screened.