On April 30, 2024, the U.S. Preventive Services Task Force (USPSTF) released its latest recommendations on screening for breast cancer in cisgender women and all other persons assigned female at birth, including transgender men and nonbinary persons. These recommendations replace breast cancer screening recommendations released in 2016. A major shift in these recommendations is to start biennial screening mammograms at age 40 years rather than at age 50 years, as had been previously advised. The recommendations note that while the incidence of BC in younger women (i.e., 40-49 years) increased from 2000 to 2015, from 2015 to 2019 there has been a 2.0% average annual rise in the number of cases in this age group.

It is recommended to continue biennial mammograms to age 74 years. For patients aged >74 years, the USPSTF stated that the current evidence is insufficient to assess the balance of benefits and harms of screening mammograms and that continuation of screening mammograms should involve patient/clinician shared decision-making that assesses both health status and longevity.

For women with dense breasts, the USPSTF concluded that there is insufficient evidence to assess the balance of benefits and harms of supplemental screening for BC using breast ultrasonography or MRI if the screening mammogram is negative.

The USPSTF cautioned that the recommendations do not apply to those who have a genetic marker or syndrome associated with a high risk of BC, such as BRCA1 or BRCA2 genetic variation. They also are not applicable to women with a history of high-dose radiation therapy to the chest at a young age, those who previously had BC, or those who had a high-risk breast lesion on previous biopsies. However, these recommendations do apply to women with an increased risk of BC, such as those with a first-degree family member with BC or those with dense breasts. BC screening can be performed using either digital mammography or digital breast tomosynthesis (i.e., 3D mammography).

The recommendations also address disparities related to race and ethnicity. They call for prompt follow-up of abnormal screening mammograms and the initiation of effective treatment for all women diagnosed with BC.

The recommendation statement lists BC screening resources for healthcare professionals and patients from the National Cancer Institute and the CDC.

Additionally, the USPSTF statement references its 2019 recommendation on the use of medications to reduce the risk of BC in women. This statement advised that clinicians should offer BC risk-reducing medications such as tamoxifen, raloxifene, or aromatase inhibitors to women who are at increased risk for developing BC and who are at low risk forexperiencing adverse drug events. However, it does not favor the routine use of these agents in women who are not at increased risk for BC.

While USPSTF does not endorse any tool for assessing risk, it does cite the National Cancer Institute’s Breast Cancer Risk Assessment Tool and the Breast Cancer Surveillance Consortium’s Risk Calculator. The USPSTF also recommends using a combination of risk factors to identify women at increased risk for BC (e.g., age ≥65 years with one first-degree relative with BC; age ≥45 years with more than one first-degree relative with BC, or one first-degree relative who developed BC when aged <50 years; age ≥40 years with a first-degree relative with bilateral BC; or the presence of atypical ductal or lobular hyperplasia or lobular carcinoma in situ on a previous biopsy).

Pharmacists should be knowledgeable about these latest recommendations, and they should encourage eligible women to undergo screening mammograms. When applicable, pharmacists can also initiate a dialogue with the patient and provider regarding the appropriateness of medication for BC prevention in high-risk patients.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.