Mammograms play a key role in the early breast cancer detection and can save lives. However, breast cancer screening comes with drawbacks like generating false positives and irrelevant biopsies. Widely debated questions include when women should start getting a mammogram and how often women should get mammograms. Two expert groups – the U.S. Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS) – differ in their opinion on this matter. The updated breast cancer screening recommendations, which now advise starting mammograms at age 40, carry important implications for earlier detection, potentially improved survival rates, and shifts in clinical practice and insurance coverage policies. Let’s take a look at the key aspects of the new mammography guidelines released by these experts.
New Mammography Guidelines from the USPSTF and ACS
U.S. Preventive Services Task Force (USPSTF) breast cancer screening updates 2024:
- Starting at age 40:Recommends that all women should get screened for breast cancer every other year starting at age 40 and continuing through age 74.
- Biennial screening: For women within the 40-74 age range, the task force recommends screening every two years, also known as biennial screening.
- Insufficient evidence for older women: The USPSTF found insufficient evidence to make a recommendation for or against screening for women 75 years and older.
The USPSTF emphasizes shared decision-making between patients and their healthcare providers, acknowledging that individual circumstances and preferences should be considered. The USPSTF urgently calls for research in key areas such as whether and how additional screening might help women with dense breasts find cancers earlier.
American Cancer Society (ACS) breast cancer screening recommendations:
According to the ACS, for screening purposes, a woman is considered to be at average risk if she does not have a personal history of breast cancer, a strong family history of breast cancer, or a genetic mutation known to increase risk of breast cancer (such as in a BRCA gene), and has not had chest radiation therapy before the age of 30. Women should be familiar with how their breasts normally look and feel and report any changes to a healthcare provider right away.
The ACS screening guidelines for women at average risk for breast cancer are:
- Women between 40 and 44 have the option to start screening with an annual mammogram, considering their individual risk factors and preferences.
- Women 45 to 54 should get mammograms every year.
- Women 55 and older can switch to a mammogram every other year, or they can choose to continue yearly mammograms. Screening should continue as long as a woman is in good health and is expected to live at least 10 more years.
However, the ACS recommendations for women at higher-than-average risk for breast cancer are as follows:
- Women with certain risk factors (e.g., family history, genetic mutations, prior chest radiation therapy) should undergo yearly mammograms and breast MRIs, typically starting at age 30.
- Risk assessment: Women should be evaluated for breast cancer risk, preferably starting around age 25, to determine the most appropriate screening strategy.
The ACS emphasizes that women should discuss their individual risk factors and preferences with their healthcare provider to determine the most appropriate screening schedule.
Varying Guidelines on Breast Cancer Screening
USPSTF (as of April 30, 2024)
- Recommendation: Biennial (every 2 years) screening mammography for those at average risk.
- Age range: Ages 40 to 74 years – lowered from the previous standard of starting at 50
- For individuals aged 75 and older, there is insufficient evidence to recommend for or against screening.
- For those with dense breasts, supplemental screening (e.g., ultrasound or MRI) also has insufficient evidence to support recommendation
ACS
- Option to start: Ages 40 to 44, annual mammography optional (i.e., you may start early).
- Standard interval: Ages 45 to 54, annual mammograms strongly recommended.
- Ages 55 and older: Can transition to biennial (every 2 years), or continue annual, based on preference.
- When to stop: Continue as long as the individual is in good health and has a life expectancy of at least 10 years.
- Note: ACS recommends shared decision-making-considering individual risk factors and preferences.
Key Differences at a Glance
| Aspect | USPSTF (2024) | ACS |
| Start age | Begin at 40, screening every 2 years | Option to start at 40, recommended at 45 |
| Screening interval | Biennial (every 2 years) | Annual (45–54), then biennial or annual (55+) |
| End age | Up to 74; ≥75, no recommendation | Continue as long as healthy and 10+ years life expectancy |
| Dense breasts | Insufficient evidence for supplements | Supplemental imaging considered via shared decisions |
The USPSTF update in April 2024 reflects rising breast cancer incidence among women aged 40–49 (about 2% per year from 2015–2019), prompting earlier routine screening.
The ACS already supported early screening-with an established preference for annual exams beginning at 45, flexible starting at 40, and continuation based on health status
The ACS expressed support for the updated USPSTF that lowered the starting age to 40, noting it aligns more with their guidelines. However, ACS remains concerned that USPSTF doesn’t address women over 74, many of whom remain healthy and at risk.
Key Takeaway
- USPSTF: Recommends every 2 years starting at age 40, stops at 74.
- ACS: Recommends annual screening starting at 45, optional from 40, with flexibility beyond 55 and into older ages if health allows.
Breast cancer screening for women typically involves regular mammograms, clinical breast exams, and potentially supplemental imaging like MRI. Women should be aware of the signs and symptoms of breast cancer and perform monthly breast self-exams. They should discuss their individual risk factors and screening options with their doctor to develop a personalized screening plan. Healthy lifestyle choices, such as maintaining a healthy weight, exercising regularly, and limiting alcohol consumption, may reduce the risk of breast cancer.
| Stay informed about your health, talk to your doctor today to understand how the new mammography guidelines apply to you. |