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Breast cancer is the most common cause of cancer-related deaths for women around the world. Regular breast cancer screening through mammograms, however, can reduce death rates by an impressive 40% (Seely, 2018).
In general, the recommendation is to get yearly mammograms starting at age 40. That said, there are some instances when you may want to get one earlier. Let’s look at the benefits of mammograms, what age most women start getting them, and how to determine what age is right for you to start.
What is a mammogram?
A mammogram is an X-ray used to screen for breast cancer. Mammograms can detect the disease in its early stages––even years before any symptoms of cancer appear.
If detected early, treatment is much more likely to be effective. Finding cancer in its early stages usually requires less intensive treatment or chemotherapy, making it easier to cure.
Studies have found people who get regular mammograms have a 40% lower chance of dying from the disease within ten years. They are also 25% less likely to develop advanced breast cancer (Seely, 2018; Duffy, 2020).
When do most women start getting mammograms?
For women with an average risk of getting breast cancer, the current screening guidelines recommend starting between the ages of 40 and 44. You’re considered to have an average risk of breast cancer if you (Oeffinger, 2015):
- Have no personal or family history of breast cancer
- Don’t have a genetic mutation linked to increased cancer risk (like BRCA1 or BRCA2 genes)
- Have not had chest radiation therapy before age 30
Previously, the American Cancer Society recommended annual mammograms beginning at age 45. However, more recent research by the American College of Radiology and Society of Breast Imaging shows getting the process done earlier (at age 40) provides the best protection against death from the disease.
So, why 40? Compared to those who start later, people who screen at this age are more likely to have smaller tumors and early-stage breast cancer. This means they’re more likely to be diagnosed earlier, have more surgical options, and have successful treatment with chemotherapy (Monticciolo, 2021).
What are the signs and symptoms of breast cancer?
Can I get a mammogram before age 40?
If earlier detection is better, you may be wondering why it’s not recommended to start mammography even earlier.
One reason is that false positives with mammography are more common in younger women, leading to follow-up tests like another mammogram, breast ultrasound, or biopsy. These tests are more invasive, take up more time and money, and create unnecessary anxiety (Seely, 2018).
Another risk of early breast cancer screening is overdiagnosis and overtreatment. Doctors may find benign tumors that would have gone away on their own or not cause any problems. As a result, women may undergo treatment that might not have been necessary and could lead to additional side effects and expenses. Some researchers estimate as many as 1 in 5 women are overdiagnosed with breast cancer when in fact, they have something benign (Siu, 2016).
After age 40, the benefits of regular screening far outweigh these potential harms (Monticciolo, 2021). Until then, women ages 25–39 with an average risk of breast cancer should get a clinical breast exam and risk reduction counseling every 1 to 3 years (Budh, 2021). During your appointment, your OB-GYN or nurse practitioner should help you assess your risk of breast cancer and provide recommendations for lifestyle changes you can make, if necessary, to lower your risk.
Recommendations for people with an increased risk of breast cancer
There are some situations where your healthcare provider may recommend getting screened earlier than age 40. For example, women at high risk of breast cancer or with dense breasts should get both a mammogram and breast MRI every year starting at age 30 (Saslow, 2007; Budh, 2021).
How do you know if you have a higher chance of developing breast cancer? Here are some of the main risk factors (Oeffinger, 2015; Alkabban, 2021):
- You’ve had chest radiation therapy between ages 10 and 30
- You carry the BRCA gene or have a family history of the disease
- You’ve had breast cancer in the past
- You have a medical condition that increases the risk, such as Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome
- You have a first-degree relative with one of the above conditions or who carries BRCA gene mutations.
- You have an increased lifetime risk of breast cancer.
You can determine your lifetime risk of breast cancer by reviewing your family history. If one of your immediate family members has had breast cancer, you have a 2–3 times higher risk of developing it yourself.
You can also use the Breast Cancer Risk Assessment Tool provided by the National Cancer Institute. Keep in mind this tool isn’t perfect and doesn’t account for personal history of some cancers or the presence of BRCA genes. It’s also been shown to be less accurate at predicting the risk in certain ethnic groups, such as people of Asian descent (Wang, 2018).
Postmenopausal health changes and common symptoms
How often should I get a mammogram?
As long as you don’t have an increased risk of breast cancer, you can start getting annual mammograms at age 40.
Once you reach age 55, you can continue getting them every year. Breast cancer screenings should continue for the duration of your life, as long as you’re in otherwise good health and expected to live for another 10 years (Budh, 2021; Monticciolo, 2021).
Starting in your mid-50s, you may be able to switch from annual screenings to doing it every other year. Experts recommend this for women in their 50s and up, but more recent research strongly recommends getting mammograms every year (starting at age 40) and continuing to do so for the rest of your life (Budh, 2021).
While regular, annual mammograms might mean needing to come back for more tests, it also significantly reduces the chance of dying from breast cancer (Monticciolo, 2021). For example, in a study comparing women who participated in regular mammography versus those who did not, the women who got regular mammograms had a 47% lower risk of dying from breast cancer over the next 20 years (Tabár, 2018).
You can talk more with a healthcare provider or specifically with your gynecologist about the best screening options for you based on your age, risk of breast cancer, and medical history. In between annual appointments, perform a monthly breast self-exam. If you notice any changes to your breasts, making an appointment is the best way to go.
- Alkabban, F. M. & Ferguson, T. (2021). Breast Cancer. In StatPearls [Internet]. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29493913/
- Budh, D. P. & Sapra, A. (2021). Cancer Breast Screening. In StatPearls [Internet]. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32310510/
- Duffy, S. W., Tabár, L., Yen, A. M., Dean, P. B., Smith, R. A., Jonsson, H., et al. (2020). Mammography screening reduces rates of advanced and fatal breast cancers: Results in 549,091 women. Cancer, 126(13), 2971–2979. doi: 10.1002/cncr.32859. Retrieved from https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.32859
- Mahoney, M. C. (2007). Breast cancer risk reduction and counseling: lifestyle, chemoprevention, and surgery. Journal of the National Comprehensive Cancer Network, 5(8), 702–710. doi: 10.6004/jnccn.2007.0071. Retrieved from https://pubmed.ncbi.nlm.nih.gov/17927927/
- Monticciolo, D. L., Malak, S. F., Friedewald, S. M., Eby, P. R., Newell, M. S., Moy, L., et al. (2021). Breast cancer screening recommendations inclusive of all women at average risk: Update from the ACR and Society of Breast Imaging. Journal of the American College of Radiology 18(9), 1280–1288. doi: 10.1016/j.jacr.2021.04.021. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28648873/
- Oeffinger, K. C., Fontham, E. T., Etzioni, R., Herzig, A., Michaelson, J. S., Shih, Y. C. T., et al. (2015). Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society. JAMA, 314(15), 1599–1614. doi: 10.1001/jama.2015.12783. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26501536/
- Saslow, D., Boetes, C., Burke, W., Harms, S., Leach, M. O., Lehman, C. D., et al. (2007). American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA: A Cancer Journal for Clinicians, 57(2), 75–89. doi: 10.3322/canjclin.57.2.75. Retrieved from https://pubmed.ncbi.nlm.nih.gov/17392385/
- Seely, J. M. & Alhassan, T. (2018). Screening for breast cancer in 2018-what should we be doing today?. Current Oncology (Toronto, Ont.), 25(1), S115–S124. doi: 10.3747/co.25.3770. https://pubmed.ncbi.nlm.nih.gov/29910654/
- Siu, A. L., & U.S. Preventive Services Task Force (2016). Screening for breast cancer: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine, 164(4), 279–296. doi: 10.7326/M15-2886. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26757170/
- Tabár, L., Dean, P. B., Chen, T. H., Yen, A. M., Chen, S. L., Fann, J. C., et al. (2018). The incidence of fatal breast cancer measures the increased effectiveness of therapy in women participating in mammography screening. Cancer, 125(4), 515–523. doi: 10.1002/cncr.31840. Retrieved from https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.31840
- Wang, X., Huang, Y., Li, L., Dai, H., Song, F., & Chen, K. (2018). Assessment of performance of the Gail model for predicting breast cancer risk: a systematic review and meta-analysis with trial sequential analysis. Breast Cancer Research, 20(1). doi: 10.1186/s13058-018-0947-5. Retrieved from https://breast-cancer-research.biomedcentral.com/articles/10.1186/s13058-018-0947-5
Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.