AAFP Backs Updated USPSTF Breast Cancer
Screening Guidance

The “B” level guidance, released in draft form last spring, estimated that this broader age range could save 19% more lives than the previous USPSTF recommendation on this topic, which had advised starting biennial mammography at age 50.  

The task force’s updated guidance — issued April 30 with an infographic, a summary for clinicians and a discussion guide for clinicians and patients — repeats the 2016 finding that insufficient evidence exists to “assess the balance of benefits and harms of supplemental screening for breast cancer using breast ultrasonography or MRI in women identified to have dense breasts on an otherwise negative screening mammogram, and the balance of benefits and harms of screening mammography in women 75 years or older.” It adds that digital mammography and digital breast tomosynthesis remain effective primary screening modalities. 

The Academy’s concurrence with the new recommendation follows a detailed review by the AAFP Commission on Health of the Public and Science, in consultation with the AAFP Science Advisory Panel. That process flagged some caveats, including 

• the USPSTF’s reliance on indirect evidence from a self-commissioned modeling report, and 

• an absence of new studies on the benefits and harms of lowering the age of initiating screening mammography from 50 to 40 years identified during the evidence review. 

The Science Advisory Panel nevertheless backed the Academy’s endorsement of the new mammography recommendation.

No Change to Most FPs’ Approach

“I don't think this should change most family physicians’ approach to screening mammography,” AAFP member Kenny Lin, M.D., M.P.H., says of the recommendation. 

Lin, associate director of the Lancaster General Hospital Family Medicine Residency in Pennsylvania, recently published a commentary in Medscape on the topic. In it, he noted that “screening messages are less complicated when guidelines agree,” while highlighting the importance of “individual decision-making based on patient preferences and values.” 

Elaborating on that first point, he told AAFP News, “Most of our patients have been conditioned by other guidelines —  e.g., the American Cancer Society, the American College of Radiology —  to expect to discuss breast cancer screening beginning in their 40s. An important point to communicate is that the guidance changed primarily because the composition of the Task Force changed from 2016 to 2024, not because there was a pivotal new study published or dramatic improvement in screening technology. 

“Knowing this, patients in their 40s can compare their personal values to the values that experts assigned to the benefits and harms of mammograms, and follow the guideline if they align or make an informed choice to delay being screened if they do not."