Science
To save Black lives, panel urges regular mammograms for all women ages 40 to 74
To counteract growing rates of breast cancer in younger women and to reduce racial disparities in deaths, an influential panel has changed its advice and is urging most women to begin getting regular mammograms at age 40.
The new recommendations from the U.S. Preventive Services Task Force say women without genetic mutations that make it extremely likely they will develop breast cancer should get their first mammogram to screen for the disease at age 40 and should continue with the exams every other year until they turn 74. The guidelines were published Tuesday in the Journal of the American Medical Assn.
Breast cancer is one of the most common cancers among women in the U.S., as well as one of the deadliest. An estimated 297,790 U.S. women were diagnosed with the disease last year, and 43,170 died of it, according to the American Cancer Society.
The task force, a group of 16 experts convened by the federal government, sparked an uproar 15 years ago when it said women could wait until 50 to begin regular, biennial breast cancer screening — much later and less frequent than what other medical groups were recommending at the time. The group’s rationale was that women in their 40s faced a low risk of breast cancer and that frequent testing of asymptomatic women in this age group caused too many to endure biopsies and other invasive procedures that were unnecessary and potentially dangerous.
The task force reaffirmed its controversial position in 2016. But when the time came to update its guidelines again, two facts stood out.
First, the incidence of invasive breast cancer in younger women, which had been slowly climbing since at least 2000, began to accelerate around 2015, rising by an average of 2% per year over the following four years.
Second, the task force recognized that among all racial and ethnic groups, Black women are most likely to be diagnosed with breast cancers that have progressed beyond stage 1, including the aggressive “triple negative” tumors that are particularly difficult to treat. Black women also have the highest mortality rate from breast cancer — about 40% higher than that of white women — “even when accounting for differences in age and stage at diagnosis,” the task force wrote in JAMA.
After analyzing data from randomized clinical trials and models based on real-world data, the panel determined that starting biennial mammograms at 40 instead of 50 would prevent an additional 1.3 breast cancer deaths per 1,000 women over the course of their screening lifetimes. For Black women, starting a decade earlier would avert an additional 1.8 deaths per 1,000 women.
“This is a big change, absolutely,” said Dr. Stamatia Destounis, chair of the American College of Radiology Commission on Breast Imaging. “We all realize that if you start to screen a woman at 40, you’re going to find the most cancers.”
Robert Smith, the American Cancer Society’s senior vice president for early cancer detection science, said the task force’s new guidance is more in line with advice from other medical organizations, including his own.
“We don’t want any woman to have a breast cancer diagnosed late if it can be avoided,” Smith said. “There’s no substitute for finding a breast cancer sooner in its natural history.”
But Ricki Fairley, founder and chief executive of Touch, the Black Breast Cancer Alliance in Annapolis, Md., said that if the goal is to reduce racial disparities, screening starting at age 40 isn’t nearly enough.
“I’m dealing with patients right now that are 24, 23, and are having breast cancer and dying,” said Fairley, a breast cancer survivor who was diagnosed at age 55. “Getting a first mammogram at age 40 is way too late for Black women.”
Reonna Berry, president and co-founder of the African American Breast Cancer Alliance in Minneapolis, criticized the task force for sticking with its advice to screen every other year.
“If we waited every two years to get a mammogram, a lot of Black women would be dead,” said Berry, who was diagnosed with breast cancer at 38 and again a few years ago, in her late 60s.
The American College of Radiology and the Society of Breast Imaging recommend annual screening starting at 40. The American Cancer Society recommends annual screenings for 45- to 54-year-olds, then screening every year or two after that. In addition, the ACR advises Black women to conduct a risk assessment and devise a screening strategy with a doctor when they are 25, Destounis said.
Smith said that although Black women under 40 are more likely than their white counterparts to be diagnosed with breast cancer, the difference isn’t large enough to warrant widespread screening.
According to data gathered by the National Cancer Institute, there are 38 breast cancer cases per 100,000 Black women between the ages of 30 and 34, compared with 32.3 cases per 100,000 white women in the same age group. For women ages 35 to 39, the respective figures are 74.8 and 69.2. In both age groups, that amounts to fewer than 6 additional breast cancers per 100,000 women.
Smith and others criticized the task force for failing to endorse screening mammograms for women over 74. As in years past, the panel determined there wasn’t enough evidence to make a recommendation one way or another.
“At the age of 75, the risk of breast cancer is very high,” Smith said.
There are 473.2 cases per 100,000 women of all racial and ethnic backgrounds between the ages of 75 and 79, and 425.8 cases for ages 80 to 84, the National Cancer Institute reports.
“There’s no reason, at least in our judgment, that women should stop screening as long as they’re in good health and expect to live another 10 years,” Smith said.
Dr. John B. Wong, a vice chair of the task force, said the lack of evidence regarding mammograms for older women is “totally frustrating.”
There are no randomized clinical trials with women in this age group, but the panel did consider a cohort study of more than 1 million Medicare patients that found no benefit to screening women ages 75 to 84, Wong said.
The situation was similar regarding the use of ultrasound or MRI as supplemental screening tools for women with dense breasts, he said.
“We know that they’re at increased risk, and we know mammography doesn’t work as well for them,” Wong said. “We would love to have some evidence to help us decide what to recommend about what they should do.”
On the question of screening frequency, the task force had enough data to act. With biennial screening between the ages of 40 and 74, there will be about 1,376 false-positive results per 1,000 women over their lifetimes, along with 14 instances of doctors finding and treating early-stage tumors that might never have become dangerous if left alone. Both would increase by about 50% if women were screened annually, Wong said.
The panel concluded that screening every other year prevents more deaths and results in more years of life gained per mammogram, producing a better balance of benefits and harms.
Dr. Julie Gralow, chief medical officer for the American Society of Clinical Oncology, said she would weigh those trade-offs differently.
“As a breast cancer doctor, I’m on the receiving end of everybody who’s diagnosed, and I think they way overplayed the harms versus the benefits,” she said, particularly the anxiety that would stem from being asked to come in for follow-up imaging. “I know for some women that’s very scary and all, but it’s almost a paternalistic kind of view.”
That notion was echoed by Karen Eubanks Jackson, founder and CEO of Sisters Network, a national breast cancer organization for Black women.
“We understand that having too many mammograms can sometimes not be in your favor,” said Jackson, a breast cancer survivor. “But as a Black woman having had it four times, I’d rather be false positive than be positive and not know it. Give me my choice.”
Gralow emphasized that the task force recommendations do not apply to women with any kind of breast abnormality.
“If you have any symptom, then you should go straight to diagnostics, and that should be done at any age,” she said.
In Smith’s ideal world, precision medicine would allow doctors to replace broad guidelines with individualized screening recommendations based on the information in each woman’s health records.
“They might say, ‘Start screening at an earlier age’ or ‘Screen every year’ or ‘You can go every other year, and that’s just as safe,’ ” Smith said. “The sooner we move in that direction, the better.”
Science
Pink Fire Retardant, a Dramatic Wildfire Weapon, Poses Its Own Dangers
From above the raging flames, these planes can unleash immense tankfuls of bright pink fire retardant in just 20 seconds. They have long been considered vital in the battle against wildfires.
But emerging research has shown that the millions of gallons of retardant sprayed on the landscape to tame wildfires each year come with a toxic burden, because they contain heavy metals and other chemicals that are harmful to human health and the environment.
The toxicity presents a stark dilemma. These tankers and their cargo are a powerful tool for taming deadly blazes. Yet as wildfires intensify and become more frequent in an era of climate change, firefighters are using them more often, and in the process releasing more harmful chemicals into the environment.
Some environmental groups have questioned the retardants’ effectiveness and potential for harm. The efficiency of fire retardant has been hard to measure, because it’s one of a barrage of firefighting tactics deployed in a major fire. After the flames are doused, it’s difficult to assign credit.
The frequency and severity of wildfires has grown in recent years, particularly in the western United States. Scientists have also found that fires across the region have become faster moving in recent decades.
There are also the longer-term health effects of exposure to wildfire smoke, which can penetrate the lungs and heart, causing disease. A recent global survey of the health effects of air pollution caused by wildfires found that in the United States, exposure to wildfire smoke had increased by 77 percent since 2002. Globally, wildfire smoke has been estimated to be responsible for up to 675,000 premature deaths per year.
Fire retardants add to those health and environmental burdens because they present “a really, really thorny trade-off,” said Daniel McCurry, an assistant professor of civil and environmental engineering at the University of Southern California, who led the recent research on their heavy-metal content.
The United States Forest Service said on Thursday that nine large retardant-spraying planes, as well as 20 water-dropping helicopters, were being deployed to fight the Southern California fires, which have displaced tens of thousands of people. Several “water scooper” amphibious planes, capable of skimming the surface of the sea or other body of water to fill their tanks, are also being used.
Two large DC-10 aircraft, dubbed “Very Large Airtankers” and capable of delivering up to 9,400 gallons of retardant, were also set to join the fleet imminently, said Stanton Florea, a spokesman for the National Interagency Fire Center in Boise, Idaho, which coordinates national wildland firefighting efforts across the West.
Sprayed ahead of the fire, the retardants coat vegetation and prevent oxygen from allowing it to burn, Mr. Florea said. (Red dye is added so firefighters can see the retardant against the landscape.) And the retardant, typically made of salts like ammonium polyphosphate, “lasts longer. It doesn’t evaporate, like dropping water,” he said.
The new research from Dr. McCurry and his colleagues found, however, that at least four different types of heavy metals in a common type of retardant used by firefighters exceeded California’s requirements for hazardous waste.
Federal data shows that more than 440 million gallons of retardant were applied to federal, state, and private land between 2009 and 2021. Using that figure, the researchers estimated that between 2009 and 2021, more than 400 tons of heavy metals were released into the environment from fire suppression, a third of that in Southern California.
Both the federal government and the retardant’s manufacturer, Perimeter Solutions, have disputed that analysis, saying the researchers had evaluated a different version of the retardant. Dan Green, a spokesman for Perimeter, said retardants used for aerial firefighting had passed “extensive testing to confirm they meet strict standards for aquatic and mammalian safety.”
Still, the findings help explain why concentrations of heavy metals tend to surge in rivers and streams after wildfires, sometimes by hundreds of times. And as scrutiny of fire suppressants has grown, the Forestry Service has set buffer zones surrounding lakes and rivers, though its own data shows retardant still inadvertently drifts into those waters.
In 2022, the environmental nonprofit Forest Service Employees for Environmental Ethics sued the government in federal court in Montana, demanding that the Forest Service obtain a permit under the Clean Water Act to cover accidental spraying into waterways.
The judge ruled that the agency did indeed need to obtain a permit. But it allowed retardant use to continue to protect lives and property.
Science
2024 Brought the World to a Dangerous Warming Threshold. Now What?
At the stroke of midnight on Dec. 31, Earth finished up its hottest year in recorded history, scientists said on Friday. The previous hottest year was 2023. And the next one will be upon us before long: By continuing to burn huge amounts of coal, oil and gas, humankind has all but guaranteed it.
The planet’s record-high average temperature last year reflected the weekslong, 104-degree-Fahrenheit spring heat waves that shuttered schools in Bangladesh and India. It reflected the effects of the bathtub-warm ocean waters that supercharged hurricanes in the Gulf of Mexico and cyclones in the Philippines. And it reflected the roasting summer and fall conditions that primed Los Angeles this week for the most destructive wildfires in its history.
“We are facing a very new climate and new challenges, challenges that our society is not prepared for,” said Carlo Buontempo, director of the Copernicus Climate Change Service, the European Union monitoring agency.
But even within this progression of warmer years and ever-intensifying risks to homes, communities and the environment, 2024 stood out in another unwelcome way. According to Copernicus, it was the first year in which global temperatures averaged more than 1.5 degrees Celsius, or 2.7 degrees Fahrenheit, above those the planet experienced at the start of the industrial age.
For the past decade, the world has sought to avoid crossing this dangerous threshold. Nations enshrined the goal in the 2015 Paris agreement to fight climate change. “Keep 1.5 alive” was the mantra at United Nations summits.
Yet here we are. Global temperatures will fluctuate somewhat, as they always do, which is why scientists often look at warming averaged over longer periods, not just a single year.
But even by that standard, staying below 1.5 degrees looks increasingly unattainable, according to researchers who have run the numbers. Globally, despite hundreds of billions of dollars invested in clean-energy technologies, carbon dioxide emissions hit a record in 2024 and show no signs of dropping.
One recent study published in the journal Nature concluded that the absolute best humanity can now hope for is around 1.6 degrees of warming. To achieve it, nations would need to start slashing emissions at a pace that would strain political, social and economic feasibility.
But what if we’d started earlier?
“It was guaranteed we’d get to this point where the gap between reality and the trajectory we needed for 1.5 degrees was so big it was ridiculous,” said David Victor, a professor of public policy at the University of California, San Diego.
The question now is what, if anything, should replace 1.5 as a lodestar for nations’ climate aspirations.
“These top-level goals are at best a compass,” Dr. Victor said. “They’re a reminder that if we don’t do more, we’re in for significant climate impacts.”
The 1.5-degree threshold was never the difference between safety and ruin, between hope and despair. It was a number negotiated by governments trying to answer a big question: What’s the highest global temperature increase — and the associated level of dangers, whether heat waves or wildfires or melting glaciers — that our societies should strive to avoid?
The result, as codified in the Paris agreement, was that nations would aspire to hold warming to “well below” 2 degrees Celsius while “pursuing efforts” to limit it to 1.5 degrees.
Even at the time, some experts called the latter goal unrealistic, because it required such deep and rapid emissions cuts. Still, the United States, the European Union and other governments adopted it as a guidepost for climate policy.
Christoph Bertram, an associate research professor at the University of Maryland’s Center for Global Sustainability, said the urgency of the 1.5 target spurred companies of all kinds — automakers, cement manufacturers, electric utilities — to start thinking hard about what it would mean to zero out their emissions by midcentury. “I do think that has led to some serious action,” Dr. Bertram said.
But the high aspiration of the 1.5 target also exposed deep fault lines among nations.
China and India never backed the goal, since it required them to curb their use of coal, gas and oil at a pace they said would hamstring their development. Rich countries that were struggling to cut their own emissions began choking off funding in the developing world for fossil-fuel projects that were economically beneficial. Some low-income countries felt it was deeply unfair to ask them to sacrifice for the climate given that it was wealthy nations — and not them — that had produced most of the greenhouse gases now warming the world.
“The 1.5-degree target has created a lot of tension between rich and poor countries,” said Vijaya Ramachandran, director for energy and development at the Breakthrough Institute, an environmental research organization.
Costa Samaras, an environmental-engineering professor at Carnegie Mellon University, compared the warming goals to health officials’ guidelines on, say, cholesterol. “We don’t set health targets on what’s realistic or what’s possible,” Dr. Samaras said. “We say, ‘This is what’s good for you. This is how you’re going to not get sick.’”
“If we were going to say, ‘Well, 1.5 is likely out of the question, let’s put it to 1.75,’ it gives people a false sense of assurance that 1.5 was not that important,” said Dr. Samaras, who helped shape U.S. climate policy from 2021 to 2024 in the White House Office of Science and Technology Policy. “It’s hugely important.”
Scientists convened by the United Nations have concluded that restricting warming to 1.5 degrees instead of 2 would spare tens of millions of people from being exposed to life-threatening heat waves, water shortages and coastal flooding. It might mean the difference between a world that has coral reefs and Arctic sea ice in the summer, and one that doesn’t.
Each tiny increment of additional warming, whether it’s 1.6 degrees versus 1.5, or 1.7 versus 1.6, increases the risks. “Even if the world overshoots 1.5 degrees, and the chances of this happening are increasing every day, we must keep striving” to bring emissions to zero as soon as possible, said Inger Anderson, the executive director of the United Nations Environment Program.
Officially, the sun has not yet set on the 1.5 target. The Paris agreement remains in force, even as President-elect Donald J. Trump vows to withdraw the United States from it for a second time. At U.N. climate negotiations, talk of 1.5 has become more muted compared with years past. But it has hardly gone away.
“With appropriate measures, 1.5 Celsius is still achievable,” Cedric Schuster, the minister of natural resources and environment for the Pacific island nation of Samoa, said at last year’s summit in Azerbaijan. Countries should “rise to the occasion with new, highly ambitious” policies, he said.
To Dr. Victor of U.C. San Diego, it is strange but all too predictable that governments keep speaking this way about what appears to be an unachievable aim. “No major political leader who wants to be taken seriously on climate wants to stick their neck out and say, ‘1.5 degrees isn’t feasible. Let’s talk about more realistic goals,’” he said.
Still, the world will eventually need to have that discussion, Dr. Victor said. And it’s unclear how it will go.
“It could be constructive, where we start asking, ‘How much warming are we really in for? And how do we deal with that?’” he said. “Or it could look very toxic, with a bunch of political finger pointing.”
Science
U.S. Efforts to Cut Emissions Stalled in 2024 as Power Demand Surged
America’s efforts to cut its climate change pollution stalled in 2024, with greenhouse gas emissions dropping just a fraction, 0.2 percent, compared to the year before, according to estimates published Thursday by the Rhodium Group, a research firm.
Despite continued rapid growth in solar and wind power, emissions levels stayed relatively flat last year because demand for electricity surged nationwide, which led to a spike in the amount of natural gas burned by power plants.
The fact that emissions didn’t decline much means the United States is even further off-track from hitting President Biden’s goal of slashing greenhouse gases 50 percent below 2005 levels by 2030. Scientists say all major economies would have to cut their emissions deeply this decade to keep global warming at relatively low levels.
Since 2005, United States emissions have fallen roughly 20 percent, a significant drop at a time when the economy has also expanded. But to meet its climate goals, U.S. emissions would need to decline nearly 10 times as fast each year as they’ve fallen over the past decade. That seems increasingly unlikely, experts say, especially since President-elect Donald J. Trump has promised to dismantle Mr. Biden’s climate policies and promote the production of fossil fuels, the burning of which generates greenhouse gases.
“On the one hand, it is notable that we’ve now seen two years in a row where the U.S. economy grew but emissions went down,” said Ben King, an associate director at the Rhodium Group. “But it’s far from enough to achieve our climate targets.”
The biggest reason that U.S. emissions have fallen in recent years is that electric utilities have been retiring their older, dirtier coal-fired power plants and replacing them with cheaper and less-polluting natural gas, wind and solar power. That trend mostly continued last year, with a few unexpected ups and downs.
The nation’s demand for electricity, which has stayed more or less flat for two decades, suddenly jumped by roughly 3 percent in 2024, in large part because scorching heat during the summer caused many Americans to crank up their air-conditioners. A smaller factor was that tech companies have been building more energy-hungry data centers in states like Virginia and Texas.
While power companies installed large numbers of wind turbines, solar panels and batteries last year to meet rising demand, natural gas use also rose to record highs, while coal use declined only slightly. The net result was that emissions from the power sector increased an estimated 0.2 percent, according to the Rhodium Group.
At the same time, transportation, the nation’s largest source of greenhouse gases, saw an 0.8 percent rise in emissions last year. Gasoline and jet fuel consumption both increased as Americans continued to drive and fly more after the pandemic. Nearly 10 percent of new car sales in 2024 were less-polluting electric vehicles, but those models still make up a small fraction of total cars on the road and have yet to put a major dent in transportation emissions.
On the flip side, emissions from America’s industrial sector — which includes steel, cement and chemicals — fell by 1.8 percent in 2024. Some of that may have been the result of lost output, as two hurricanes and a strike at the nation’s ports disrupted some factory activity in the fall, Mr. King said.
“It’s a reminder that there’s always some bumpiness in emissions,” Mr. King said. “It’s not just a question of how many electric vehicles are on the road or how much solar we’ve installed. A big portion of our economy still relies on fossil fuels.”
One of the most striking findings in this year’s data was that emissions from oil and gas operations dropped roughly 3.7 percent in 2024. Even though the United States produced record amounts of oil and near-record amounts of natural gas last year, many companies appear to have curbed leaks of methane, which is the main ingredient in natural gas and which can seep into the atmosphere and contribute significantly to global warming.
Over the past few years, the Biden administration and several states have adopted new regulations that require oil and gas producers to detect and fix methane leaks. Many companies also have financial incentives to capture methane to sell rather than vent it into the air.
Between 2014 and 2024, U.S. companies appear to have reduced the amount of methane that escaped, per each cubic feet of gas they produced, by 40 percent, according to the Rhodium Group.
Several experts have estimated that greenhouse gases generated in the United States could start dropping sharply in the years ahead if many clean energy policies stay in place, particularly the 2022 Inflation Reduction Act that pumped hundreds of billions of dollars into low-carbon energy technologies such as electric vehicles, wind turbines, solar panels, nuclear reactors, green hydrogen and batteries.
While Mr. Trump has pledged to scrap many of Mr. Biden’s subsidies and tax credits for electric vehicles and low-carbon energy, it remains to be seen whether Congress will agree.
That law has not yet had a major impact on the country’s emissions, said Mr. King, since it takes time for new factories to open and power plants to get built. But, he said, data shows that low-carbon energy and transportation now make up fully 5 percent of total U.S. private investment.
“That’s a leading indicator that things are changing quickly,” he said.
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