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Health Panel Recommends Starting Mammograms at Age 40

The switch addresses a significant disparity and is expected to save thousands of lives


spinner image woman getting a mammogram being helped by the tech
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A national panel of experts recommends that women bump up their breast cancer screenings by a decade and start getting regular mammograms at 40, rather than 50, and continue with them every other year through age 74.

The final recommendation issued April 30 from the U.S. Preventive Services Task Force is based on previous research that shows the switch could save roughly 8,000 lives each year. Breast cancer is the second-most-common cancer in women, behind skin cancer. About 310,720 new cases are expected to be diagnosed in 2024, according to the American Cancer Society, and more than 42,000 women are expected to die from breast cancer this year.  

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While most breast cancers are diagnosed in people over age 50, radiologist Toma Omofoye, M.D., says we’re seeing the cancer more often in younger adults, though researchers aren’t clear on why. “So, it’s important to make sure that our guidelines match the timelines to find the cancers at their smaller sizes,” when treatment is more likely to be successful, says Omofoye, an associate professor in the Department of Breast Imaging at the University of Texas MD Anderson Cancer Center in Houston.

What’s more, breast cancers diagnosed in younger women tend to be more aggressive, and therefore may grow faster, says Maxine S. Jochelson, M.D., chief of the Breast Imaging Service at Memorial Sloan Kettering Cancer Center in New York City.

“More women in their 40s have been getting breast cancer, with rates increasing about 2 percent each year, so this recommendation will make a big difference for people across the country,” task force chair Wanda Nicholson, M.D., said in a statement.

The task force notes that the change could have a positive impact especially on Black women, who are 40 percent more likely to die from breast cancer than white women, and who are more likely to be diagnosed with breast cancer before age 50. Research shows Black women are also more likely to have aggressive subtypes of breast cancer than their white counterparts.

“We need to know how best to address the health disparities related to breast cancer so all women can live longer and healthier lives,” said task force vice chair John Wong, M.D. 

While many factors feed into this striking disparity, Omofoye says Black women often experience delays on the care continuum — from diagnosis to treatment. “And I think that since we know that Black women do have more delays in general, it’s important that we give them access to care earlier, rather than later,” she adds.

Streamlining recommendations

If you’ve ever been confused on when to go in for your mammogram — an X-ray picture of the breast — you’re not alone. Before these new guidelines, the task force recommended that women at average risk for breast cancer get a mammogram every other year from age 50 to 74, and that women in their 40s should make a decision with their doctor.

Meanwhile, expert groups like the American Cancer Society and the American College of Radiology have said women at average risk for breast cancer should start screening in their 40s.

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Streamlining the guidelines so that women know they should be going in for their first mammogram at age 40 helps to cut down on the confusion over when screening should begin, Omofoye says. However, the task force and other professional groups are still out of sync when it comes to how often women need a mammogram.

When the task force issued its draft screening recommendations in May 2023, the American Cancer Society released a statement applauding the updated recommendations to begin screening starting at age 40. “However, further consideration may be required as to the frequency of screening for women under age 55. Current evidence indicates that biennial [every-other-year] screening in this population is associated with a diagnosis of more advanced disease,” said William Dahut, M.D., chief scientific officer for the American Cancer Society.

Likewise, Jochelson says she “firmly believes” that women, and especially younger women, should be screened every year. “Again, younger women have more aggressive cancers. And you certainly don’t want to give a cancer two years to grow when you can find it a year earlier.”

The task force considers the potential harms and benefits of screening when making its recommendations and concluded that the best balance comes from screening every other year. An example of a potential harm is the risk of receiving a false positive, which can cause anxiety among patients called back for biopsies and more testing.

However, Omofoye says many women are willing to take that risk if it means catching cancer at a more treatable stage. “I think that the risk of a false positive versus the risk of a missed cancer are not equivalent,” she says.

Jochelson points out that the majority of breast imaging centers use 3-D mammography, and that this technology has been shown to reduce callback rates for women who don’t have cancer.

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Talk to your doctor about risks

It’s important to note that with the updated guidelines, 40 is the latest age that women at average risk should start regular screenings for breast cancer. Some women, including those who have already had breast cancer or who are at high risk for it, are encouraged to start younger and screen more frequently.

If you have not had your risk for breast cancer assessed, talk to your doctor, Jochelson urges. You may be eligible for supplemental imaging. Plus, if it turns out you’re at high risk, you’ll want to inform others in your family that their risks could also be elevated, she adds.

The task force recommendations don’t include specific screening guidance for the roughly half of women in the U.S. who have dense breasts, which can increase breast cancer risks and interfere with mammogram readings.

“Women deserve to have the best science available to guide them on how to protect their health, and we’re asking the research community to prioritize studies that can show us how best to screen for breast cancer in women with dense breasts,” the task force’s Nicholson said in a statement. “In the meantime, women with dense breasts should talk with their clinician about options for follow-up testing so that they can get the care that’s right for them.”

Task force members are also calling for more research into the benefits and harms of screening in women 75 and older, and say that women in this age group should talk to their doctor about what’s best for them. The American Cancer Society recommends that women continue with mammograms if they are in good health and are expected to live at least 10 more years.

“For now, the most important thing for women to know is to begin screening at the age of 40, because it just might save your life,” says task force immediate past chair Carol Mangione, M.D., a professor of medicine and public health at the University of California, Los Angeles.

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