When do you need to start getting a mammogram? Here's what new recommendations say.
Breast cancer screening guidelines have made the news again. On Tuesday, the U.S. Preventive Services Task Force (USPSTF) announced that it had finalized its recommendation, first drafted in May 2023, that women get screened every other year starting at age 40, continuing through age 74. Previous guidelines recommended that screenings begin at the age of 50.
According to a press statement from the USPSTF, "More research is needed about whether and how additional screening might help women with dense breasts stay healthy and on the benefits and harms of screening in women older than 75." The USPSTF also noted that Black women have a 40% higher risk of dying from breast cancer compared to white women, and therefore it's important that they begin screenings at age 40. That said, this screening is "not enough to improve the existing inequities" in health care for Black women, the statement continued.
The statement also clarified that the USPSTF's guidance "applies to women at average risk of breast cancer, as well as those with a family history of breast cancer and those with dense breasts." Those with a high risk for breast cancer should speak to their doctors about when to initiate screenings.
"The recommendation does not apply to people who have a personal history of breast cancer, who are at very high risk of breast cancer due to certain genetic markers or a history of high-dose radiation therapy to their chest at a young age or who have had a high-risk lesion on previous biopsies," the USPSTF said. "Anyone concerned with their breast health should talk with their health care professional."
Reacting to the new USPSTF guidance, representatives from Susan G. Komen, the leading breast cancer foundation, said that there should be a more personalized approach to breast cancer screenings. The organization said that a "one-size-fits-all model is outdated in the era of precision medicine. Each individual's unique risk factors, including family history, genetic predisposition and lifestyle factors, must be carefully considered to optimize screening effectiveness and improve outcomes."
And while the organization expressed support for lowering the screening age to 40, they are in favor of women getting screened annually, not every other year as the USPSTF recommends.
“Annual screenings provide the best opportunity for individuals to detect their cancers early when treatment options are easier and survival rates are higher,” said Paula Schneider, president and CEO of Susan G. Komen and a breast cancer survivor. “Everyone deserves a personalized breast cancer screening plan tailored to their unique needs, determined in partnership with their trusted health care provider.”
Screening guidelines have long been subject to both debate and confusion. Read on to see what experts in the field say about the benefits and risks of early screenings.
What recent research says about screenings
According to a study published on Feb. 20 in the journal Radiology, which looked at different age recommendations for breast cancer screenings, women should undergo annual mammograms starting at the age of 40 and continue until the age of 79. The study authors say this can result in the highest reduction in mortality with minimal risks.
While research shows that consistent screenings can reduce breast cancer mortality by 40% (breast cancer is the second most common cause of cancer death for women in the U.S.), statistics show that roughly less than 50% of eligible women opt for an annual mammogram, as reported in the Radiology study. While there are several reasons why some women aren’t getting regular screening mammograms, including cost and not having health insurance or access, conflicting information about when to actually get one may also be a factor.
After all, the recommendations for breast cancer risk assessment can vary, depending on the medical panel. For example, while the American Cancer Society says women should have the choice to get screened for breast cancer between the ages of 40 and 44, it advises getting annual mammograms for women between the ages of 45 and 54. So should all women start getting screened sooner rather than later? Plus, are there any possible risks involved for those who choose to have a mammogram in their 40s? Here’s what experts say.
When should women start getting screening mammograms?
While some women are already getting their first mammogram at age 40, experts say that for those who planned to get it later, they may now consider starting at 40 and bringing it up with their health care provider.
That said, there is no one-size-fits-all answer. “This is an ongoing debate, and different organizations have different recommendations about starting mammograms at 40 vs. 45 vs. 50 years old,” Dr. Natalie J. Klar, medical oncologist and assistant professor of medicine at NYU Langone's Perlmutter Cancer Center, tells Yahoo Life.
Dr. Jessica Shepherd, ob-gyn and chief executive officer of Sanctum Med + Wellness, tells Yahoo Life that the USPSTF is one of seven leading independent organizations and panels that make breast cancer screening recommendations, as well as other cancer care guidelines. “The new recommendation advises all women to get screened for breast cancer every other year, from ages 40 to 74,” she says. “The USPSTF also acknowledged that Black women — who are 40% more likely to die from breast cancer than white women — are more likely to be diagnosed in their 40s and with more aggressive breast cancers.”
It’s also worth noting that there's been an increase in younger patients developing breast cancer, says Klar. The Centers for Disease Control and Prevention (CDC) states that about 9% of all new cases of breast cancer in the U.S. are diagnosed in women under the age of 45, and a 2023 study published in the Porto Biomedical Journal found that the incidence of breast cancer in women under 40 has been on the rise, which experts say is a disturbing trend. “There is also literature that has shown that the rate of breast cancer among women ages 40 to 49 increased by 2% per year, on average, from the years of 2015 to 2019,” Shepherd says.
Who is most at risk for developing early breast cancer?
The CDC reports that certain risk factors can increase a woman’s chances of developing breast cancer under the age of 45, such as:
Having close relatives who were diagnosed with breast cancer at the age of 45 or younger
Having more than one close relative diagnosed with breast cancer and/or a close male relative diagnosed with breast cancer
Having been diagnosed with ovarian cancer or having a close relative diagnosed with ovarian cancer at any age
Having mutations in certain breast cancer genes (BRCA1 and BRCA2) or having close relatives with these mutations
Having dense breasts
Having Ashkenazi Jewish heritage
Having received radiation therapy to the breast or chest area
Having breast health problems, such as lobular carcinoma in situ (LCIS) (a type of noncancerous breast change where cells grow in the lining of the milk-producing glands of the breast)
Do the benefits of early screenings outweigh the risks?
There are some downsides to early screenings. Patients in their 40s who elect to get a screening mammogram have a higher rate of false positives, says Klar. “In other words, a finding that leads to further workup, such as additional imaging and potential biopsy, that ends up being benign — meaning noncancerous. These false positive findings can be stressful and anxiety-provoking for patients.”
Overdiagnosis — also referred to as overdetection and defined as the detection of tumors that would not become symptomatic or life-threatening — is another possible risk, says Shepherd. A systematic review and meta-analysis of 30 studies published in the Journal of Personalized Medicine found that overdiagnosis due to screening mammography for breast cancer occurred in 12.6% of women aged 40 and older. However, researchers from Yale School of Medicine’s COPPER Center point out that older women in particular — aged 70 and above — are more likely to be at risk of overdiagnosis with breast cancer.
“The risks of screening are nonlethal and manageable for most women,” Dr. Debra L. Monticciolo, professor of radiology at Dartmouth Geisel School of Medicine in Hanover, N.H., stated in a press release on Feb. 20. “But advanced breast cancer is often lethal. Breast cancer is easier to treat if it’s found earlier; we’re able to spare women extra surgeries and chemotherapy. It’s just a better idea to shift to early detection, and that’s what screening does.”
The bottom line
Patients should consult with their health care provider to assess their risk for early breast cancer and discuss when to get a mammogram. Shepherd suggests that younger women can become their own advocate by talking to their health care provider about the benefits and possible downsides of getting a screening mammogram starting at the age of 40.
Both Shepherd and Klar say the majority of health insurance plans will cover the cost of a mammogram for patients under the age of 50. “And most plans do not require extra information to be authorized to get a mammogram,” says Shepherd.
In her statement, Monticciolo urged the medical community to support patients in getting early annual breast cancer screenings. “It comes down to valuing women’s lives,” she said. “I am hoping that primary care physicians see that the risks of screening are manageable, and the benefits are tremendous. We need to do this for women.”
This article was originally published on Feb. 26, 2024, and has been updated.
