One of the most common questions I’m asked is: “When should I start screening for breast cancer?” Not surprisingly, a common question among my older patients is, “When am I able to stop screening for breast cancer?”
Considering the conflicting information in news reports over the last decade or so, the confusion is understandable.
In May 2023, the U.S. Preventive Services Task Force (USPSTF) updated its breast screening guidelines, lowering the suggested age from 50 to 40. This change was based on recent research by the National Cancer Institute which found that breast cancer is on the rise in women 40-49, having increased 2% per year from 2015 to 2019.
Ironically, it was the USPSTF that increased the suggested age from 40 to 50 in 2009, setting off widespread media coverage and subsequent debate between patient advocacy groups, professional associations and physicians.
Women in their 40s account for nearly 20% of all screen-detected breast cancers.1 More than six years ago, a study published in the journal Cancer demonstrated that annual screening starting at age 40 reduces mortality by nearly 40%, compared with just 23.2% for biennial screening.2 The study also found that if every woman 40 years of age and older had annual mammograms, there would be 29,369 lives saved each year. Finally, it showed that mammograms should be performed annually in women up until the age of 84.
There is consensus among The American College of Obstetricians, The American College of Radiology, The Society of Breast Imaging, and the American Society of Breast Surgeons that women at average or low risk for breast cancer start screening at age 40. However, if you are at high risk or think you may be at high risk, you will want to discuss the possibility of starting screening sooner with your doctor.
Women at high risk for breast cancer are those with a strong family history of the disease, a BRCA or KRAS genetic mutation, a personal history of some breast conditions, dense breast tissue, and other factors. In addition, African American women and women of Ashkenazi Jewish descent are at a higher risk for certain types of breast cancer. These women should consider a breast cancer risk assessment at age 30 to determine if annual mammograms should begin before 40 years of age or sooner.
Knowing your risk not only improves your chances of surviving breast cancer but may also help you qualify for supplemental screening to improve your ability to achieve early detection.
Tracy S. Chen, D.O., M.P.H.
- American Journal of Roentgenology. Voume 209, Issue 3 September 2017. Screening Mammography for Women in Their 40s: The potential impact of the ACS and USFSTF breast cancer screening recommendations. Jenifer A. Pitman, et al.
- Cancer 21 August 2017 Comparison of recommendations for screening mammography using CISNET models. Elizabeth Kagan Arlea MD et al.
