New recommendations from the National Health Commission advise that women should start getting mammograms at age 40, instead of age 50, and breast cancer screening should be postponed 10 years earlier. This could save thousands of lives each year. The US Preventive Services Task Force suggests that women between ages 40 and 74 should have a mammogram screening every two years. The new guidance applies to cisgender women and everyone else assigned female at birth. Previously, biennial screenings beginning at age 50 were the formal recommendation, but women in their 40s were advised to discuss the benefits and risks of mammography with their doctor.
Breast cancer is increasing among women in their 40s, with about 2% of women newly diagnosed with breast cancer each year, according to John Wong, an internist and professor of medicine at Tufts University School of Medicine. The task force has changed its recommendations to estimate that starting screening early can catch breast cancer earlier and save more lives. There is an even greater potential benefit for Black women, who are far more likely to die from breast cancer. According to American Cancer Society data, Black women are at higher risk of developing breast cancer before age 40 than white women. They are also more likely to develop a more aggressive form called triple-negative breast cancer. Over 43,000 women die from breast cancer.
A mammogram is an X-ray of the breast that can help screen for signs of breast cancer and diagnose any palpable lumps, making it the gold standard in breast cancer screening. Many breast cancer experts welcomed the task force’s recommendations for lowering the recommended age at which women should begin screening mammograms. However, some professional organizations and physicians focused on breast health say their recommendations are not sufficient and recommend annual mammograms to screen for cancer instead of biennial screenings. They suggest that mammogram appointments are easier to remember and that spacing them one year apart between screenings gives cancer more time to grow undetected.
Many organizations make different recommendations for mammography screening, leading to confusion among women and their physicians. The American Cancer Society recommends that all women begin annual screening by age 45 and states that certain high-risk women should begin annual screening by age 40. Women with dense breasts, except women considered at high risk, such as those who had a breast biopsy or breast cancer, or those who have BRCA1 or BRCA2 gene mutations, should also receive additional imaging tests like ultrasound or MRI if there is not enough breast tissue for a mammogram.
The recommendations are based on preventive medicine, and women at high-risk should be supervised by a breast cancer specialist who can give them more individualized guidance. Women who have had all of their breast tissue removed by a mastectomy and nonbinary or transgender people who have had most (but not all) of their breast tissue removed and still have regular breast cancer screening needs are also advised to take mammograms.
The current evidence is insufficient to determine the balance of benefits and harms of supplemental breast cancer screening. Experts recommend additional research on ultrasound, MRI, or other additional screening. Once the recommendations are finalized, they will be published in JAMA, the journal of the American Medical Association.