New Mammogram Guidelines: Breast Cancer Screening Should Start at 40, Expert Panel Says

Fact checked by Nick Blackmer

News Takeaway

• The US Preventive Services Task Force (USPSTF) released new recommendations today, stating all women should start getting mammograms at age 40.

• Their previous guidance allowed that women should start mammography no later than age 50.

• Breast cancer diagnoses rose on average 2% annually from 2015 to 2019, and that’s one reason the task force said they’re recommending earlier screening.

The US Preventive Services Task Force (USPSTF) released updated guidance today recommending that women get a mammogram at least every other year beginning at age 40 and continuing until at least age 74.

The recommendation marks a shift from previous guidance from the task force which recommended that women start getting mammograms no later than age 50.

Breast cancer incidence has been on the rise in recent years: From 2015 to 2019, the average annual increase in cases was 2%, according to the new recommendation statement, published in JAMA.

The recommendations were changed to help doctors diagnose breast cancers earlier and save more lives, Wanda Nicholson, MD, MPH, MBA, chair of the USPSTF, told Health. “It’s going to help women entering into their forties,” Dr. Nicholson said, adding the recommendations could avert 1.3 deaths per every 1,000 women screened.

Other institutions—such as the American College of Radiology (ACR), the American Society of Breast Surgeons (ASBrS), and the Society of Breast Imaging (SBI)—recommend annual mammograms for women when they turn 40, Laura Dean, MD, a diagnostic radiologist at Cleveland Clinic, told Health.

Some providers say the new USPSTF recommendations don’t go far enough to protect women from breast cancer.

“While the task force recommends screening every two years, annual screening mammography saves the most lives,” Natasha Monga, MD, a breast radiologist at The Ohio State University Comprehensive Cancer Center, told Health. “Starting annual screening at age 40 also helps detect cancers when they are smaller and more easily treatable, which may lead to less aggressive treatment.”

But the new recommendations are a step in the right direction, Dr. Monga added, and experts say they could be particularly beneficial for Black women, who often have bad outcomes after being diagnosed with breast cancer due to a range of issues within the US healthcare system; the USPSTF recommendation statement points out that systemic and structural racism has created barriers that often keep Black women from receiving quality healthcare.

“Black and other minority women are more likely to be diagnosed with breast cancer at an earlier age,” Dr. Monga said. “These women are more likely to be diagnosed with advanced-stage and more aggressive forms of breast cancers and are more likely to die of breast cancer.”

Below, experts discuss the significance of the updated guidance and what to know if you’re 40 or older and you haven’t had a mammogram yet.

How the New Recommendations Will Affect Women in Their Forties

A draft of the updated guidance was released in May 2023, and today’s recommendation statement finalizes the USPSTF’s stance on the age at which mammography should start.

As such, if you’re 40 or older and you haven’t yet had a mammogram, you should schedule one. “Women between 40 and 50 years of age who have not undergone breast cancer screening already should discuss scheduling their initial screening with their healthcare providers,” Douglas Marks, MD, a medical oncologist at NYU Langone Perlmutter Cancer Center, told Health.

Many healthcare providers will likely start reaching out to patients in this category in the coming days, Dr. Nicholson added.

Under the Affordable Care Act (ACA), private health insurers often have to provide full coverage of mammograms at no cost to the patient.

The recommendations apply to all cisgender women and everyone else assigned female at birth, such as transgender men, per the new statement. The recommendations do not apply to some people who were previously diagnosed with breast cancer or those who have some genetic markers—such as BRCA1 or BRCA2 genetic variations—and people in these categories should speak with a healthcare provider to determine which screenings are best for them, and how often they need screenings. People in some of these categories who are high-risk for breast cancer may need to start getting screened earlier, and they may need more intensive screenings, Dr. Monga said.

If you are unsure about whether you need to get mammograms, your doctor can help you figure out which appointments you need to schedule and when you should get screened.

Related: Olivia Munn Says Breast Cancer Risk Assessment Score ‘Saved’ Her Life—Here’s What to Know

What Else Is Changing?

The major change outlined in the recommendation statement is the age at which all women should now start mammography, but the statement included information on other facets of breast cancer prevention as well.

“We’re also saying women can pursue either [2D] or 3D mammography, [as] the latest evidence points toward both of those opportunities to be equally effective,” Dr. Nicholson said.

Though 3D mammography helps providers diagnose more cancers, women shouldn’t skip appointments for 2D mammograms—which are what have traditionally been offered before the new 3D technology became available—if that’s all that’s available at their healthcare facility. “I would not forgo a screening mammogram for the sake of seeking out a facility with a 3D capability,” Dr. Dean said. “I would argue that a standard 2D mammogram is better than no mammogram at all,” she added, explaining that most of our research on the lifesaving capabilities of mammography is based on the 2D technology.

The recommendation statement also said more research is needed to learn how best to screen women with dense breasts and to learn how to reduce barriers to care for Black women.

An editorial published in JAMA with the recommendation statement argued that the USPSTF should have done more to address the emergence of AI tools that claim to be able to read mammograms. “We are concerned that a…swift adoption of new AI support tools may occur before there are adequate scientific data to justify use at a population screening level,” the authors wrote.

Related: 5 Lesser-Known Breast Cancer Symptoms—Because a Lump Isn't the Only Sign

How the Updated Recommendations Will Save Lives

Earlier breast cancer screenings will help doctors find and treat some tumors when they’re smaller, Dr. Dean said. She added that many women assume they don’t need screenings because they don’t know of any relatives who have had the disease.

“One thing I like to emphasize is that a lot of patients often say, ‘I never thought I would get breast cancer because no one in my family has ever had it,’” Dr. Dean said. “That’s a common misconception that comes up a lot in my day-to-day practice.”

The reality, she explained, is that 75% of breast cancers are diagnosed in women with no family history—underscoring the fact that all women are at risk of the disease and need to get screened regularly.

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