You may be confused about the right age to have your first mammogram. Until now, there was conflicting information from national societies.
But new draft guidance from the U.S Preventive Services Task Force (USPSTF) advises that all women be screened for breast cancer beginning at age 40. High-risk individuals, including Black or Ashkenazi Jewish women and those with a family history of breast cancer, should speak with their doctor by age 25 to assess their lifetime risk for breast cancer as they may qualify for screening earlier than age 40.
Breast cancer is the most common cancer among women in the U.S. and the second leading cause of cancer death in this group according to the American Cancer Society. For decades, mammograms have been considered the gold standard screening tool for the early detection of breast cancer. This updated recommendation from the USPSTF aligns with guidelines from other major national medical societies including the American College of Radiology (ACR), the Society of Breast Imaging, and the American College of Obstetricians and Gynecologists.
“The change will result in more lives saved and reduce the confusion about when to begin screening,” says Sue Jane Rivas Grosso, MD, Medical Co-Director of Breast Imaging at Summit Health.
Why did the USPSTF recommendation change?
The USPSTF acknowledges there has been an increase in breast cancer risk among women 40 to 50 years old. Several key findings and statistics motivated them to change their recommendation including:
- Approximately 1 in 6 breast cancers occur in women ages 40 to 49.
- Twenty-one percent of all breast cancers are diagnosed in women before 50 years old.
- The rate of cancer and mortality risk for breast cancer in forty-something women increased by an average of 2% each year from 2015 to 2019.
- Forty percent of the lives saved by mammography are among women ages 40 to 49.
Prior to this announcement, the USPSTF recommended that women in their 40s make an individual decision about when to start screening based on their health history and preferences. Now, they recommend all women start screening at age 40.
“Starting screening mammography in average-risk women at age 40 and on an annual basis saves the most lives,” advises Dr. Grosso. This updated guideline, she explains, will impact approximately 75% of the population.
Should anyone be screened before age 40?
There are women at a higher risk for developing breast cancer that may benefit from screening at an even earlier age. Doctors assess a patient’s risk by considering factors such as personal and family history.
Some additional mammography and breast cancer screening recommendations for women at higher risk include:
- Women with genetics-based increased risk including carriers of BRCA1 (a gene mutation that increases the chances of developing breast cancer), those with a calculated lifetime breast cancer risk of 20% or more, and those exposed to chest radiation at an early age are recommended to have MRI surveillance starting at ages 25 to 30. These women may start annual mammography at ages 25 to 40, depending on the type of risk.
- ACR also recommends that women diagnosed with breast cancer prior to age 50 or with a personal history of breast cancer and dense breasts have a breast MRI each year.
- High-risk women who would like supplemental screening — but cannot undergo MRI screening — should consider contrast-enhanced mammography (CEM).
“While knowing your risk level is key, 75% of breast cancer is found in women who are not considered high risk,” explains Benjamin Schneider, MD, Medical Co-Director of Breast Imaging at Summit Health. “That is why it is important that all women are screened each year starting at age 40.”
Should women of certain ethnicities be screened earlier?
The USPSTF and ACR are bringing attention to segments of the population that are more likely to be diagnosed with breast cancer at a younger age.
The ACR now recommends that all women — particularly Black and Ashkenazi Jewish women as well as other minority groups — undergo a risk assessment for breast cancer with their physician by age 25. This will help determine if:
- Screening before age 40 is needed. In addition to mammography, these women may also benefit from other methods for breast cancer screening such as MRI and contrast-enhanced mammography.
- Referral to a specialist such as a breast surgeon or medical oncologist is beneficial to discuss other risk-reducing strategies.
Research shows that Black and other minority women less than 50 years of age are 127% more likely to die of breast cancer, 72% more likely to be diagnosed with breast cancer, and 58% more likely to be diagnosed with advanced-stage breast cancer.
Black women are 42% more likely to die from breast cancer compared with non-Hispanic white women. Black women are also diagnosed with more aggressive cancers at younger ages.
“These new guidelines will bring attention to the public that early detection saves lives and should bring in an influx of women who have not been screened,” explains Dr. Schneider. “Recommending all women begin screening at 40 could result in 19 percent more lives being saved.”
What can you expect from your first mammogram?
Your first baseline screening mammogram will last about 20 minutes. First, you fill out a brief questionnaire about your medical history. Then, you will meet with one of our mammography technicians who will perform your exam. The screening mammogram usually consists of two views of each breast.
“If you have a lump or any other concerning symptoms, please let your doctor know,” advises Dr. Schneider. “They can evaluate you and recommend a more focused (diagnostic) mammogram and ultrasound exam to evaluate these specific symptoms.”
Are self-exams still recommended?
Most women are familiar with at-home or self-examinations. It is important to know that self-examinations have not been shown to be an effective routine screening method. However, when self-exams are used in conjunction with mammographic screening and a clinical exam of the breast by your doctor, they can be an important adjunct.
“Many medical societies do not recommend them for routine screening,” adds Dr. Grosso. “It is still important for women to be familiar with their own breasts so they have a sense of what is normal for them and can better report new changes to their doctor.”
Schedule your mammogram today
Summit Health has a team of experienced radiologists, technologists, coordinators, nurses, and patient navigators ready to assist you in every step of your breast care journey. To schedule a mammogram or any other breast imaging, please call 541-382-4900.