Every woman wants to make sure she plays it safe when it comes to breast cancer screening. Lately, though, guidance about just what age you should start to get mammograms at has been confusing.
The US Preventive Services Task Force (USPTF) used to recommend that women aged 50 to 74 of average risk get a mammogram every two years. But on April 30, 2024, the USPTF issued a statement changing its guidelines to recommend that all women assigned female at birth between age 40 and 74 should get a screening every other year.
Other health organizations maintain different guidelines based on a woman’s age, health and personal choice. For example, the American College of Radiology advises annual screening at age 40 while the American Cancer Society advises women 45 to 54 years old to get a yearly mammogram, and women age 55 and older to get one every other year. It’s important to know, though, that the ACS just issued a statement supporting the new USPTF recommendations, a position shared by breast cancer experts.
“We all agree that screening at age 40 definitely saves lives,” says Laura Hodges, MD, Director of Breast Imaging and Interventions at Montefiore Einstein Comprehensive Cancer Center, and assistant professor of radiology at Albert Einstein College of Medicine in Bronx, New York.
While all of this may sound confusing, you really should take the new USPTF recommendations seriously. The USPTF’s word matters because this US government-based volunteer panel is made up of top medical experts using strict evidence-based data to create their guidance.
There’s plenty of research to back up their recommendations, too: A new study from Washington University School of Medicine found that rates of breast cancer diagnosis have been on the rise in women under 50 for the past twenty years. The study also showed that many of the tumors younger women are diagnosed with are estrogen-receptor positive, meaning that the estrogen in a younger woman’s system actually fuels her cancer’s growth. Plus, according to data from the Centers for Disease Control, younger women tend to have more aggressive breast cancers as well. With the new recommendations, the hope is that more women will be diagnosed and treated earlier, leading to remission and good overall health outcomes.
Right now, mammograms are the most efficient screening tool we have to spot cancers early, which is especially important for certain demographics of women. For example, Mayo Clinic reports that Black women are 41% more likely to die from breast cancer, partially due to the fact that their cancer is often diagnosed at a later stage. “There is data to suggest that Black women are more likely to be diagnosed in their 40s with more aggressive breast cancers,” says Sara Tolaney, MD, MPH, chief of breast oncology at Dana-Farber Cancer Institute in Boston, MA.
In addition, once a Black woman is diagnosed, she may not receive the same life-saving care that other women receive. “Many Black women have less access to health facilities, and have inadequate healthcare coverage,” says Dr. Hodges.
To help you make the best choice for your own health, we’ve broken down all the details of the new USPTF mammogram recommendations.
Old mammogram recommendations
According to data from Yale Medicine, the USPTF did a review of existing breast cancer studies to see how effective mammograms were by age, factoring in screening intervals, the use of any additional testing to detect disease and breast cancer death rates. They also looked at information related to the age women began screening and the race of patients. Previously, there was concern that breast cancer wasn’t prevalent enough in women in their 40s to warrant earlier screening. Also, doctors were concerned that more women being screened could result in more false-positives, which could lead to more unnecessary screening and treatment women did not really need.
Another factor that has been contentious among breast cancer experts has to do with a study done in Canada from 1980 to 1992. This trial followed almost 90,000 women, and determined that yearly mammograms for women between age 40 and 49 didn’t cut the risk of death from breast cancer any more than a physical exam would. “This was a faulty trial, innately flawed in multiple ways,” says Dr. Hodges. Unfortunately, that trial informed guidelines for breast cancer screening worldwide.
New mammogram recommendations
“The Task Force recommends that all women get screened for breast cancer every other year, starting at age 40 and continuing through age 74, to reduce their risk of dying from this disease," the USPTF's statement read.
In addition to noting that "nearly half of all women have dense breasts, which increases their risk for breast cancer and means that mammograms may not work as well for them," the USPTF also called out that Black women are at higher risk of dying from breast cancer than white women, as noted above. "Ensuring Black women start screening at 40 is an important first step, yet it is not enough to improve these inequities. It’s important that patients receive equitable and appropriate follow-up after screening and effective treatment of breast cancer. We are urgently calling for more evidence to better understand whether Black women could potentially be helped by different screening strategies.”
Who is at "average risk” for breast cancer?
According to data from the American Cancer Society, you’re at average risk if:
- You don’t have a personal history of breast cancer
- You don’t have a strong family history of breast cancer
- You don’t have or a genetic mutation that can raise your risk of breast cancer, like a BRCA gene
- You didn’t have chest radiation therapy before you were 30 years old
Who is at "high risk" for developing breast cancer?
If you’re at high risk, the ACS recommends you have a mammogram and breast MRI every year from age 30. Your risk is higher if:
- You have a lifetime risk of breast cancer of about 20% to 25% or greater, based on your family history
- Genetic testing shows you have either the BRCA1 or BRCA2 gene mutation
- Your parent, brother, sister or child has a BRCA1 or BRCA2 gene mutation, and hasn’t had genetic testing
- You had chest radiation therapy before you were 30 years old
- You have Li-Fraumeni syndrome, Cowden syndrome or Bannayan-Riley-Ruvalcaba syndrome or have first-degree relatives with one of these conditions.
The bottom line
The USTPF’s new recommendations are based on good, strong data, but they may not cover you completely, and in the end, the decision on when and how often to screen comes down to maximizing safety. Some doctors believe the revised screening guidelines still aren’t sufficient. One specialist, Wendie Berg, MD, PhD, Professor of Radiology at Magee-Womens Hospital of UPMC and the University of Pittsburgh School of Medicine, just published an editorial about how, in her opinion, this is an improvement, but annual screening would be better.
So it's critical to ask your doctor for advice based specifically on your health and family history. “Early breast cancers are 98% curable,” says Dr. Hodges.
Lisa is an internationally established health writer whose credits include Good Housekeeping, Prevention, Men’s Health, Oprah Daily, Woman’s Day, Elle, Cosmopolitan, Harper’s Bazaar, Esquire, Glamour, The Washington Post, WebMD, Medscape, The Los Angeles Times, Parade, Health, Self, Family Circle and Seventeen. She is the author of eight best-selling books, including The Essentials of Theater.