Dr. Rachel Brem Congressional Testimony on the Dense Breast Notification Rule

Dr. Rachel Brem, M.D.

Professor and Vice-Chair of Radiology
Director of Breast Imaging and Intervention
George Washington University
Chief Medical Officer and Co-Founder, Brem Foundation to Defeat Breast Cancer

I am Dr. Rachel Brem, Professor of Radiology at George Washington University, Director of Breast Imaging and Intervention, and Chief Medical Officer of the Brem Foundation to Defeat Breast Cancer. My life's mission is to ensure that every woman has access to early detection and potentially life-saving treatment for breast cancer. This mission is personal—my mother was diagnosed with breast cancer when I was just 12 years old. Given only six months to live, she survived another 44 years, thanks to early detection. Later, at age 37, I found my own breast cancer while evaluating breast ultrasound equipment. My eldest daughter was 12 at the time. I know breast cancer as a daughter, a mother, a survivor, and as a world-recognized breast cancer physician.

The evidence is unequivocal: early detection saves lives. When breast cancer is caught early, more than 95% of women survive. In contrast, survival rates for late-stage breast cancer plummet to 30%. Every American woman deserves the chance to detect early, curable breast cancer. Yet, women with dense breast tissue—a condition affecting over 40% of U.S. women—are at risk of having their cancers hidden on mammograms. Fortunately, other imaging methods, such as ultrasound and MRI, can detect these "hidden" cancers. However, access to these additional screenings remains a challenge.

The USPSTF: A Flawed Decision-Making Process
I’ve been asked to provide some background and history on the United States Preventive Services Task Force

The United States Preventive Services Task Force (USPSTF) is an independent panel, convened by the U.S. Department of Health and Human Services, charged with making recommendations on preventive services, such as breast cancer screening. However, the USPSTF lacks one critical element: cancer experts. There are no oncologists, radiologists, or cancer researchers on the panel. Its members are experts in preventive medicine and primary care, with no specialists in cancer detection and treatment. This is a glaring deficiency in a group that sets national screening guidelines affecting millions of women.

The USPSTF does not conduct original research but reviews peer-reviewed studies to make its recommendations. These recommendations are given a letter grade—A, B, C, D, or I (insufficient evidence)—which carry significant consequences. Under the Affordable Care Act, private insurers must cover preventive services graded A or B by the USPSTF. Consequently, their decisions determine whether lifesaving screenings are accessible to millions of women, particularly those from lower socioeconomic backgrounds.

A Troubling History of Breast Cancer Screening Guidelines
The USPSTF's inconsistent history regarding breast cancer screening is alarming:

• In 2005, the USPSTF recommended annual mammograms for all women aged 40 and older.
• In 2009, it reversed this recommendation, suggesting women aged 40-49 should consult with their doctors rather than routinely undergo screening. Screening for women aged 50-74 was reduced to every two years.
• In 2016, despite acknowledging that the most lives are saved by starting mammography at age 40, the USPSTF maintained its recommendation for biennial screening for women aged 50-74.

Each of these changes occurred despite overwhelming scientific evidence that annual screening beginning at age 40 is the most effective way to save lives. Data shows that following the USPSTF's recommendations would result in maintaining only 81% of the reduction in mortality that could be achieved by following guidelines from leading medical organizations like the American Cancer Society and American College of Radiology. That 19% difference represents real women—mothers, daughters, sisters—whose lives could be saved.

The 2024 Guidelines: A Missed Opportunity
In 2024, the USPSTF once again adjusted its guidelines, recommending that breast cancer screening begin at age 40—but only every two years. This decision was made without any new evidence or studies. Even more concerning is the USPSTF's failure to recommend additional screening for women with dense breast tissue. This omission ignores robust scientific data showing that ultrasound, MBI, ultrasound tomography and most effectively MRI, can detect cancers that mammography alone cannot identify.

Women with dense breasts are particularly vulnerable to later-stage diagnoses. Research shows that supplemental screenings can find nearly as many cancers as mammography and that MRI can find three times as many cancers after a normal mammogram. For the USPSTF to conclude that there is "insufficient evidence" to recommend additional screening is simply unacceptable.

The Rising Threat of Breast Cancer in Younger Women
Adding to the urgency, breast cancer rates among younger women are rising. Between 2010 and 2019, cancer diagnoses among people aged 30 to 39 increased by nearly 20%, with breast cancer accounting for the highest number of cases. There are similar findings for women in their 40’s. The USPSTF's current recommendations do not adequately address these alarming trends.

Women Deserve Better
By not recommending that women with dense breasts have supplemental screening, the USPSTF is denying them the chance for early detection and cure. The panel has acknowledged that these imaging tests find more cancers, yet they continue to issue an "I" (insufficient evidence) grade for supplemental screening. This is the same mistake the Task Force made when it issued a similar grade for screening women aged 40-49—a decision it reversed years later.

We cannot afford to wait for the USPSTF to correct its mistake again. Women with dense breast tissue deserve access to the full range of imaging tests available. The potential "stress" of additional testing pales in comparison to the devastation of a late-stage cancer diagnosis. Informed women should have the right to make these decisions for themselves, not be subjected to the USPSTF's paternalistic approach.

Early detection is not just a recommendation; it is a right. We must ensure that all women, regardless of their breast density, have access to the imaging they need to find cancer early, when it is most curable. The evidence is clear, the science is sound, and the stakes could not be higher.

Let us not allow outdated or misguided recommendations to stand in the way of saving lives. Every woman deserves the chance to survive and thrive.

It is essential to support the FIND IT EARLY Act, ensuring that women receive the lifesaving tests they deserve. Women should never be forced to choose between feeding their families and accessing critical, potentially life-saving imaging. This isn’t a luxury—it’s a necessity. Congress has the responsibility to protect women’s health and ensure that life-saving screenings are accessible and affordable for all.