The Recommended Age to Start Mammograms Just Plummeted—Here’s When to Start
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The U.S. Preventive Services Task Force just issued new breast cancer screening guidelines.
The guidelines recommend starting mammograms at age 40.
Some doctors say the recommendations don’t go far enough.
Screening guidelines for breast cancer just got a major overhaul. The U.S. Preventive Services Task Force (USPSTF), which makes recommendations that influence doctor’s decisions about care (as well as insurance coverage), now recommends that women start mammograms at age 40.
The updated recommendations, published in JAMA on Tuesday, mark a big change from previous guidelines, hoping that this will help more people catch breast cancer at an earlier stage.
About 240,000 new cases of breast cancer are diagnosed in women in the U.S. each year and around 42,000 women die of the disease annually, according to data from the Centers for Disease Control and Prevention (CDC). Research shows that women who have regular mammograms are more likely to detect breast cancer early, are less likely to need aggressive treatments like surgery to remove the entire breast and chemotherapy, and are more likely to be cured, according to the American Cancer Society (ACS).
Meet the experts: Ethan Cohen, M.D., associate professor of Breast Imaging at The University of Texas MD Anderson Cancer Center; Natasha Monga, M.D., a breast radiologist with The Ohio State University Comprehensive Cancer Center—James Cancer Hospital and Solove Research Institute; Dana Ataya, M.D., a board-certified breast radiologist at Moffitt Cancer Center
“More women in their 40s have been getting breast cancer, with rates increasing about 2% each year, so this recommendation will make a big difference for people across the country,” Task Force chair Wanda Nicholson, M.D., M.P.H., M.B.A., said in a statement. “By starting to screen all women at age 40, we can save nearly 20% more lives from breast cancer overall.”
But some doctors who treat women with breast cancer say the new recommendations don’t go far enough. Here’s what the new recommendations say, plus why they’re slightly controversial.
What are the updated mammogram guidelines?
The new USPSTF recommendations suggest that women get mammograms every other year, starting at age 40 and until age 74. (The previous recommendations said that women should start mammograms every other year, starting at age 50, leaving the decision to start in their 40s up to women.)
The recommendations apply to everyone who is assigned female at birth with an average risk of breast cancer, along with people who have a family history of breast cancer or dense breasts. However, the recommendations don’t apply to people with a personal history of breast cancer, a genetic marker or syndrome that could put them at a higher risk of breast cancer, or those who have a history of high-dose radiation therapy to the chest or high-risk breast lesions. (In those cases, the USPSTF says you should stick with what your doctor recommends.)
Is there other breast cancer screening guidance?
There are other recommendations for breast cancer screening outside of the USPSTF, which can make this a little confusing. While the new recommendations put the USPSTF more in line with what other major medical organizations suggest, there is still a difference.
The ACS recommends that women have the option to start mammograms between age 40 and 44, and to start them by the time they reach 45. The ACS also says that women should get mammograms each year.
The American College of Obstetricians and Gynecologists (ACOG) recommends starting mammograms at age 40, too, with follow-ups done every year or every other year, based on shared decision-making with a patient and the doctor.
Should I get a mammogram every year?
Reactions to the updated guidelines are mixed. An accompanying editorial published in JAMA Oncology said that the new recommendations “do not go far enough.” Among other things, it says that more frequent screening is needed, and that there needs to be specific recommendations for women with dense breasts, who have an estimated lifetime risk of breast cancer of at least 20%.
“These recommendations are slightly clearer than previous ones, but they are not enough,” says Ethan Cohen, M.D., associate professor of Breast Imaging at The University of Texas MD Anderson Cancer Center. “The best way to save the greatest number of lives is to screen women every year, beginning at the age of 40.”
Natasha Monga, M.D., a breast radiologist with The Ohio State University Comprehensive Cancer Center—James Cancer Hospital and Solove Research Institute, agrees, saying that the new USPSTF guidelines “do not go far enough.”
“While the Task Force recommends screening every two years, annual screening mammography saves the most lives and is recommended by many major medical organizations,” she says. “In fact, the USPSTF, American Cancer Society, and many others agree that annual screening mammography decreases breast cancer mortality.”
Should I get a mammogram at 40 or 45?
It depends. Ultimately, it’s up to you and your doctor. But, starting annual screening at age 40 also helps detect breast cancers when they are smaller and more easily treatable, which may lead to less aggressive treatment, Dr. Monga says.
“Decades of research have shown us that yearly mammograms beginning at age 40 save the most lives,” says Dana Ataya, M.D., a board-certified breast radiologist at Moffitt Cancer Center. “So, although the updated USPSTF guidelines now support screening mammography beginning at age 40, it’s surprising that the recommendation is only for biennial—rather than annual—screening.”
But some doctors have already been recommending that women have mammograms starting at age 40—and say this won’t change the way they practice medicine. “This announcement underscores what we in the breast imaging community have been supporting for many years,” says Claire L. Streibert, M.D., site chief of breast imaging at, Fox Chase Cancer Center.
The bottom line
The USPSTF change “was a long time coming,” says Janie Grumley, M.D., breast surgical oncologist and director of the Margie Petersen Breast Center at Providence Saint John’s Center and Associate Professor of Surgery at Saint John’s Cancer Institute in Santa Monica, CA. “The recommendations before were not ideal,” she says. “We never stopped telling patients that they needed to do screenings at age 40.”
Dr. Cohen says his organization also already recommends that women are screened for breast cancer annually, starting at age 40. “Patients should also discuss breast cancer risks with their doctor to create a personalized plan,” he says.
Ultimately, doctors say it’s important to have a conversation with your doctor to understand your risks and next steps. “Women should speak with their primary care physician, especially those with an elevated risk of breast cancer,” Dr. Cohen says. “For those who face further risk, additional screening may be beneficial.”
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