Beyond the headlines: USPSTF screening guidelines, disparities, and mental health
In our May column, LBBC shares our views on breast cancer news
- 8 Min. Read
- BY: Janine E. Guglielmino MA
- Medical Review: Regina Hampton MD, FACS, Neil K. Taunk MD, MSCTS
This month the U.S. Preventive Services Task Force (USPSTF) recommended lowering to 40 the age at which women at average risk for breast cancer should begin mammography screening.
The change was prompted by the growing rates of breast cancer among young women and the consistently higher death rates among Black women. The new recommendations apply to those whose sex assigned at birth was female, a welcome inclusion of transgender people.
We’re pleased the USPSTF reversed its earlier recommendation to begin screening at age 50, but the guidelines don’t go far enough. They still say mammograms should only be done once every two years, though studies show annual screenings significantly decrease death rates. USPSTF recommendations continue to conflict with the guidelines from several other influential associations, challenging most people’s ability to have informed conversations with their doctors about their personal risk. Let the USPSTF know what you think by providing your comments at the link below by June 6.
- Breast cancer: Screening (U.S. Preventive Services Task Force)
- Health panel recommends women get screening mammograms at age 40 (Washington Post/gated content)
- When should women get regular mammograms? At 40, U.S. panel now says (The New York Times)
Related LBBC content
- Mammograms (About)
Read on to hear more about whether the age for first breast cancer screening should be based on racial and ethnic background, issues around breast density, temporarily stopping anti-estrogen therapy to attempt pregnancy, effective radiation therapy, the impact of mental health on breast cancer care, and more.
Should breast cancer screening be influenced by race?
One big reason we support lowering the age for screening mammography is that Black women are more likely to be diagnosed younger, with higher-staged and more aggressive cancers, and are more likely to die. One recent study analyzed over 400,000 breast cancer deaths over 9 years. It found Black women would benefit from starting screening at age 42, whereas women of other racial backgrounds could start after 50 and in some cases even wait until 60. Such findings suggest policy makers could recommend a risk-adapted strategy for breast cancer screening, prioritizing screening for those at highest risk for death. That is a complicated message to communicate, but some doctors already use guidelines that include death rates, such as those from the American Society of Breast Surgeons. Ask your doctor which standards they use to recommend screening for you.
Utilizing a personalized approach will allow providers and patients to make decisions best for each situation.
- Race and ethnicity-adjusted age recommendation for initiating breast cancer screening (JAMA Network Open)
- Study: Black women should start breast cancer screening at age 42 (STAT)
- Position statement on screening mammography (American Society of Breast Surgeons)
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Breast density relationship status: It’s complicated
LBBC has been talking about breast density because of legislation to inform people about their status—but also because knowing what to do about it is confusing. One study suggests that the rate at which breast density naturally declines with age could help doctors identify those at highest risk for developing cancer. It found women who were later diagnosed had a slower rate of breast density decline in the affected breast. Future research should focus on measuring changes to more accurately predict risk. In the meantime, LBBC’s home state of Pennsylvania just passed legislation that requires insurers to cover the out-of-pocket costs for genetic counseling and additional screening tests for people deemed high risk, including those with high breast density. It’s exciting legislation we hope to see replicated in other states across the country.
- Researchers identify possible new risk for breast cancer (The New York Times)
- The link between breast cancer and breast density decline (The Advisory Board Daily Briefing)
- Shapiro signs first bill, expands Pa. health insurance coverage for breast cancer screenings (WHYY)
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Mental health is health
May is Mental Health Awareness Month, and I’m always pleased to see the growing recognition of the connection between emotional health and physical outcomes. One study from Kentucky showed that those who developed depression before or after a breast cancer diagnosis were less likely to receive guideline-driven treatments, resulting in a higher risk of death. Fortunately, the American Society of Clinical Oncology has a guideline hot off the press that advises all people with cancer be educated about depression and anxiety. ASCO’s guideline provides doctors with specific, evidence-based mental health treatments for people with cancer. While it may take time for these guidelines to be adopted, I encourage you to ask for help now if your diagnosis makes it harder for you to function, cope, or make decisions about your daily life and breast cancer care. You are worth it.
Depression management is important for breast cancer patients after diagnosis, as is maintaining continuity of care for patients with depression pre-diagnosis. It can ultimately affect the patient’s long-term survival.
- Management of anxiety and depression in survivors of cancer: ASCO guideline update (Journal of Clinical Oncology)
- New study finds link between depression and breast cancer survival (Everyday Health)
- Influence of depression on breast cancer treatment and survival: A Kentucky population-based study (Cancer/gated content)
- It’s Mental Health Awareness Month: Here’s how 4 survivors cope with cancer’s emotional toll (Cure)
Related LBBC content
- Depression (About) and Anxiety (About)
- Navigating breast cancer and bipolar disorder: Deb’s story (podcast)
- Healing body and emotions: Shangrong Lee (blog)
Treatment breaks for pregnancy
Good news for women with early-stage, hormone receptor-positive breast cancer who want to temporarily stop anti-estrogen therapy to attempt pregnancy: the POSITIVE trial showed no increased risk for distant recurrence after three years. LBBC reported the findings from San Antonio last December, and now the full study is available. Lead author and LBBC medical advisory board member Dr. Ann Partridge says it’s important to follow people over the long-term, but these findings suggest a temporary treatment vacation is safe.
Cancer takes away so much control for people. This allows them to add back some element of control in terms of their planning for their future and that of their family.
- Interrupting endocrine therapy to attempt pregnancy after breast cancer (New England Journal of Medicine)
- Women who’ve had breast cancer can safely pause treatment for pregnancy (Science News)
- After early-stage breast cancer, interrupting endocrine therapy to become pregnant didn’t raise risk of recurrence (STAT)
Related LBBC content:
Trade-offs in radiation therapy
Researchers are constantly searching for better and less toxic ways to deliver treatment. After a decade of follow-up, the AMAROS clinical trial shows radiation therapy can safely replace further surgery to remove cancer in axillary lymph nodes—a procedure that significantly increases the risk for lymphedema. On the other hand, the IRMA trial found that people who got accelerated partial-breast radiation, which gives two treatments a day over a single week compared to the standard, much longer course of whole breast radiation therapy, resulted in more bone side effects and a worse cosmetic outcome. Weighing risks and benefits of therapy can help you and your doctor select the right option for you.
AMAROS continues to demonstrate that women can receive axillary nodal radiation in place of an axillary dissection in the setting of a positive sentinel node biopsy. For most patients in this scenario, surgical de-escalation is an appropriate and safe option.
- Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer: 10-year results of the randomized controlled EORTC 10981-22023 AMAROS trial (New England Journal of Medicine/gated)
- Cosmetic results and side effects of accelerated partial-breast irradiation versus whole-breast irradiation for low-risk invasive carcinoma of the breast: The randomized phase III IRMA trial (Journal of Clinical Oncology/gated)
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(Our) people are talking
- Last month several of our amazing Leadership Volunteers spoke publicly at LBBC’s 2023 Conference on Metastatic Breast Cancer, including the four panelists on our Learning from each other panel, Thomasina Butler, Sheila Godreau, Cheryl Law, and Deb Ontiveros. Thank you for sharing your stories!
- LBBC Young advocate grad Roberta “Bobby” Albany shared photos and tweets from her trip to San Francisco as a patient advocate rep on the Southwest Oncology Group’s breast committee. Bobby helps clinical trials get off the ground, run effectively, and share the results.
- Jae Troskosky of the 2022 Young Advocate class shared their breast cancer story with Survivornet to educate the community about disparities in care for LGBTQ+ people. Thank you, Jae!
- Congratulations to LBBC medical advisory board member Helen L. Coons, PhD, ABPP, who received the 2023 Joseph D. Matarazzo Award for Distinguished Contributions to Psychology in Academic Health Centers from the Association of Psychologists in Academic Health Centers.
Look for our reports next month from Chicago, where LBBC staffers Shehzin Teitjen, Catherine Ormerod, and I will be attending the 2023 American Society of Clinical Oncology meeting to bring you the latest news from clinical trials and our partners!
- Our advocates (SWOG)
- 31-year-old caregiver’s world turned upside down with breast cancer diagnosis: The importance of equality in cancer care (SurvivorNet)
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Thank you to Claire Nixon, our consulting medical editor, for lending her expertise to this month’s column.
Please send us items for the June issue at email@example.com.