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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


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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 new draft recommendation from the U.S. Preventive Services Task Force is based on emerging research that shows the switch could save roughly 8,000 lives each year. Breast cancer is the second-most-common cancer in women, affecting more than 264,000 each year. It’s also one of the deadliest, according to the National Cancer Institute, claiming the lives of more than 43,000 annually.

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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.

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.

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.

Task force vice chair Wanda Nicholson, M.D., says in a statement that ensuring Black women start screening at age 40 is an important first step, but that more needs to be done to improve the inequities we’re seeing. 

“In our draft recommendation, we underscore the importance of equitable follow-up after screening and timely and effective treatment of breast cancer and are urgently calling for more research on how to improve the health of Black women,” says Nicholson, who is with the Milken Institute School of Public Health at George Washington University.

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. Up until now, 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. 

On May 9, the American Cancer Society issued 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, 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 in its draft 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.

“We know that women with dense breasts are at higher risk of breast cancer and, unfortunately, mammograms do not work as well for them,” says task force member John Wong, M.D., a professor of medicine at Tufts University School of Medicine. “What we don’t know yet, and what we are urgently calling for more research on, is whether and how additional screening for women with dense breasts might be helpful, including through ultrasound, breast MRIs, or something else.”

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 their mammograms if they are in good health and are expected to live at least 10 more years.

The task force’s draft recommendations, which apply to all people assigned female at birth, are open for public comments through June 5, after which final guidelines will be issued.

“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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