May 16, 2023 — DenseBreast-info.org has issued a statement which states that the USPSTF Guideline should not apply to women with dense breasts, stating that the newly released United States Preventive Services Task Force (USPSTF) breast cancer screening recommendations are written for women at “average” risk for breast cancer. But women with dense breasts are at higher risk. Further, the task force incorrectly concludes there is “inadequate” evidence to support adding screening MRI (or ultrasound if MRI is not possible) after a mammogram for many women with dense breasts.
Dense Breasts and Higher Risk
The task force guideline only addresses women at average risk yet includes women with dense breasts or with a family history of breast cancer in that group. The task force did not consider combinations of risk factors. Many women with dense breasts also have a family history of breast cancer and meet current “high-risk” criteria (greater than 20% lifetime risk). In these women, annual screening with MRI is recommended, in addition to annual mammography, by the American Cancer Society (ACS), National Comprehensive Cancer Network (NCCN) guidelines, American College of Radiology (ACR) Appropriateness Criteria, and the 2023 ACR Screening Recommendations for Women at Higher than Average Risk. MRI, or ultrasound if MRI is not possible, should be recommended in women where annual mammography alone is inadequate, and this includes all women at higher risk.
FDA Final Rule
A new FDA rule going into effect in September 2024 will require all women be told that dense tissue makes it harder to find breast cancer on a mammogram and also raises the risk of developing breast cancer. In women with the densest breasts, about 40% of cancers are missed on a mammogram. About 40% of women of mammography age have dense breasts.
FDA, Additional Testing and Insurance Coverage
With the FDA final rule, women with dense breasts will also be informed, “in some people with dense tissue, other imaging tests in addition to mammography may help find cancers.” Women with dense breasts will be told other imaging tests are helpful, but, because the USPSTF does not recognize the benefit of this additional testing, their insurance may not cover such testing.
Why it Matters
Insurance, medicare, and the affordable care act rely on USPSTF recommendations to determine coverage of screening tests. Additional testing may not be covered by insurance if not recommended by the USPSTF. Women who need additional breast imaging tests may not be able to afford them due to lack of insurance coverage.
Need for the Find It Early Act
Many women with dense breasts are at higher risk for breast cancer and for missed cancer on a mammogram. Therefore, the USPSTF recommendations should not be applied to these women. The current USPSTF recommendations may cause confusion and prevent women who need additional screening from being able to access and afford it. The proposed bipartisan insurance coverage bill, the Find It Early Act (introduced by Reps. DeLauro and Fitzpatrick), may help. Insurance coverage should be consistent with NCCN Guidelines and ACR Appropriateness Criteria, and the Find It Early Act would ensure this for all women.
DenseBreast-info.org urges people to support the Find it Early Act, and offers details for contacting your congressperson here.
For more information: www.densebreast-info.org