A proposed recommendation aimed at catching breast cancer early and saving lives could have more people getting mammograms at age 40. The U.S. Preventive Services Task Force is considering lowering the recommended age for a first mammogram from 50 to 40. The recommendation would apply to cisgender women and people assigned female at birth.
If you’re thinking, “Wasn’t it already 40? That’s when I had my first mammogram,” you are right. Some professional medical organizations already recommend screening at age 40.
“Previously, screening in your 40s may have been a more individual decision, rather than a strong recommendation for everyone,” explains Jessica L. Fraker, M.D., a breast specialist at Mayo Clinic in Phoenix, Arizona. “Adding that age group will help save lives from breast cancer. And we’re seeing breast cancers in that age group.”
The U.S. Preventive Services Task Force makes recommendations about what preventive care services would help people live long, healthy lives. Many primary care professionals use these recommendations to guide their patients’ care. Breast, gynecology or radiology specialists might follow different recommendations of their respective professional groups.
At what age should women begin mammogram screening?
If the proposed guideline passes, more healthcare providers will recommend that women begin breast cancer screenings at age 40. The recommendation is based on inclusive research showing that earlier screenings save lives.
In particular, earlier screenings are expected to save the lives of Black women. Black women are more likely than white women to get aggressive forms of breast cancer and get breast cancer at younger ages. These new guidelines will hopefully help address the inequality.
Breast cancer is the second most common type of cancer for women. Skin cancers are the most common. The average age of breast cancer diagnosis is 62.
At what age can women stop getting mammograms?
The proposed guideline suggests that women continue getting mammograms once every two years until age 74. But people should discuss the benefits and risks of continuing screening beyond 74 with their healthcare team.
“Really, what it comes down to is if you were to get a breast cancer, would you go through all these treatments, and would that help you survive or help your quality of life?” Dr. Fraker says.
A healthy patient in her 80s might say yes, so it might make sense to continue having mammograms.
“I think it’s reasonable to keep screening if that’s the decision you come to together with your healthcare provider,” Dr. Fraker says. “Whereas if you have someone who’s maybe not in as good of health, maybe wouldn’t do so well with the breast cancer treatment or wouldn’t want to go through breast cancer treatment, maybe we stop screening and putting them through that every year.”
How does breast density affect mammogram recommendations?
Nearly half of all women have dense breasts. This means more of the tissue in their breasts is made up of milk glands, milk ducts and supportive tissue than fat tissue. Having dense breast tissue is normal and common. But it also makes cancerous masses more difficult to see on the mammogram. Women are often notified after their mammogram if they have dense breast tissue.
“The reason that we care about your breast density is because it does potentially increase your risk for breast cancer,” Dr. Fraker says. “And it makes your screening mammograms less sensitive at finding breast cancers, especially small early breast cancers.”
Mammograms are still a very useful tool in detecting breast cancer. But people with dense breasts might want to talk to their healthcare team about what is best for them when it comes to breast cancer screenings.
“There are multiple options out there that, depending on your risk level and your preferences, could be added with your mammogram to help with finding breast cancers earlier,” Dr. Fraker says.
How does having a family history of cancer affect mammogram recommendations?
Having a biological relative with a history of certain cancers could prompt your healthcare team to recommend that you start screening at a younger age.
Talk to your healthcare provider if you have a family history of breast cancer. You may benefit from additional discussion regarding your individual risk, when you should start screening, and any additional measures you should be taking to catch breast cancer early or reduce your risk for breast cancer.
If you have a higher risk for breast cancer, your healthcare team might recommend breast screenings beginning at age 40 or 10 years before the first affected relative was diagnosed. So if your grandmother was diagnosed at age 45, you might consider having your first mammogram at age 35.
How often do you need a mammogram?
The U.S. Preventive Services Task Force currently recommends having a mammogram every two years. But you and your healthcare team might decide to screen every year.
“There is still discussion about this in the medical community, and some medical societies do recommend annual screening, so every year might be more appropriate for some individuals,” Dr. Fraker says.
What are the risks of a mammogram?
Mammograms do come with some risk. First, the chest area is exposed to a small amount of radiation. Mammograms also have the potential to trigger anxiety.
“Any breast-related screening tends to bring up nerves, understandably,” Dr. Fraker says. “Especially if you’re starting early or younger for some reason.”
Any medical imaging can have false negatives. That means cancer was present but missed. Screenings also have false positives, meaning that something looks abnormal on a mammogram, so the person comes back for additional tests. Often, those initial findings are benign, meaning they are not cancer. But those additional tests and time waiting can cause anxiety and worry. There is also the concern for overdiagnosis — finding breast cancers that would not have caused the patient harm.
Medical associations weigh the benefits and risks, and generally agree that the benefit of finding breast cancer early outweighs the risks.
How to handle mammogram anxiety
If you feel anxious about your mammogram, mention your concerns to your healthcare team. They might be able to help. For example, if you’re worried about pain, you may be able to take acetaminophen (Tylenol) or ibuprofen (Aleve, Motrin IB, others) before the test. Your team also might be able to use some techniques to make the procedure easier. You also can use warm or cool compresses on any sore areas after the test.
Also, ask your healthcare team how you’ll receive your test results. Will they call or will you see the results in your online medical record? Dr. Fraker says it’s common for her patients to receive their test results in their online portals before she has even seen them. If the thought of seeing your results on your own makes you anxious and you’d prefer to get a phone call, let your healthcare team know.
What’s the difference between a diagnostic mammogram and a screening?
As far as the mammogram experience goes, diagnostic and screening mammograms are similar. The main difference is why you’re getting a mammogram.
A screening mammogram is the routine screening you get when you don’t have any concerns or symptoms. The standard test is two different views of each breast.
If your screening mammogram showed something of concern or you have a lump, pain or other breast symptom, you might need a diagnostic mammogram. Your mammogram team might get some additional views of the concerning area to further evaluate it.
Talk to your healthcare team
Ultimately, which cancer screenings you get and how often are your decision. The guidelines are there to help catch problems early when treatment might be more effective. Talk to your healthcare team about your personal risks and benefits.
Relevant reading
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