The answer might surprise you.
This past October, we reported on the startling increase in younger-onset breast cancer diagnoses and what might be causing it. Now, preventative measures are being implemented to protect more women from developing the disease.
According to guidance issued this week by the U.S. Preventive Services Task Force (USPSTF), millions more women should be getting mammograms.
The expert panel finalized a draft recommendation (which was made public last year) that recommends women start undergoing routine mammograms when they turn 40; the recommended age was previously 50. Here’s a closer look at why they made the change, what else they’re suggesting, and why some breast cancer advocates aren’t happy with the revision.
When should you get your first mammogram?
The task force, which is an influential panel of independent experts that offer guidance for when and how we should get screened for cancer, made the change because more and more women in their 40s are being diagnosed with the disease. Among this demographic, rates have crept up 2 percent every year between 2015 and 2019, per the National Cancer Institute, and the task force estimates that the new guidelines could save 20 percent more lives compared to the old guidance.
“There is clear evidence that starting screening every other year at age 40 provides sufficient benefit that we should recommend it for all women in this country to help them live longer and have a better quality of life,” John Wong, M.D., vice chair of the task force, told The New York Times.
These new guidelines don’t apply to women who have a personal history of breast cancer or those with a genetic marker for the condition (like a mutation of the BRCA gene) — these women are advised to get screened earlier and more often.
The guidance also doesn’t apply to women 74 and older and it doesn’t endorse extra scans like MRIs and ultrasounds for women with dense breasts — stances that the group is being criticized for.
The American Cancer Society CEO Karen Knudsen said in a statement that the nonprofit is “disappointed” that the recommendations don’t cover older women.
“Millions of women over age 75 are in very good health and are expected to live many more years during which their risk of breast cancer remains high,” she said. “The ACS does not support stopping screening for anyone with a 10-plus year life expectancy irrespective of age.”
Connecticut Rep. Rosa DeLauro, whose bill would require insurance companies to cover additional screenings for women with dense breasts, wrote that she worries the recommendations “miss the mark” and fail to protect women with this type of breast tissue.
The task force has said that there isn’t enough evidence to support the need for women with dense breasts to undergo alternative screening methods, but some studies show that these tools can help detect cancers that traditional mammograms miss.
“Adding ultrasound or MRI to an annual mammogram helps us find earlier, more-treatable breast cancers in women with dense breast tissue,” Robyn Gartner Roth, M.D., a breast radiologist, wrote for Katie Couric Media when the draft was released last year.
She was also disturbed by the two-year recommendation. “Two-year intervals are too long, especially in young women and minorities who are more likely to develop aggressive breast cancers, have dense breast tissue, and die from their breast cancer. Skipping a year of mammography can lead to delays in diagnosis and worse outcomes; we learned this the hard way during the COVID-19 pandemic.” She also believes screenings shouldn’t stop at age 74. “Breast cancer is more common and mammography is more accurate as you get older, so why stop at age 74? Plus there are constantly evolving, less aggressive treatments that are optimal for the older population.”
What is a mammogram?
A mammogram is simply an X-ray photo of the breast that doctors use to look for early signs of breast cancer. After the mammogram is done, a radiologist will read it and give the results to you and your doctor.
How often should you get a mammogram?
Different organizations have different guidelines. The USPSTF recommends that women who are at average risk for breast cancer get a mammogram every two years to avoid false positives. The American Cancer Society and other organizations, however, advise annual mammograms to avoid giving undetected cancers more time to grow. Discuss the ideal frequency for you with your doctor.
Should older women still get mammograms?
As we mentioned earlier, the USPSTF advises biennial mammography screening until age 74. But it’s unclear what the suggestion is after that; the task force noted that there wasn’t enough evidence to assess the risks and benefits of mammograms in women older than 74. The research that has been conducted as to the benefits of screening beyond the age of 74 is mixed. Still, one 2009 study found “continuing screening to age 79 (versus 69) results in a median increase in percent mortality reduction of 8 percent (range 7–11 percent) and 7 percent (6–10 percent) under annual and biennial intervals, respectively.” It should be noted that the same study found “that initiating screening at age 40 saves more life years than extending screening past age 69.”
Results from a more recent study from 2023 suggest “that the risk of overdiagnosis with routine screening mammography is substantial for women in their 70s and older.” According to Cancer.gov, overdiagnosis refers to a test that does find cancer. “But it’s a cancer that will grow very slowly — or not at all — and would never cause problems during someone’s lifetime. Treatment for such cancers would, by definition, be unnecessary.”
Clearly, it’s still up for debate, making it a conversation you should have with your medical team.
Why should you get one?
The scary reality is that “the majority of women who are diagnosed with breast cancer have no easily identifiable risk factors,” Katerina Dodelzon, MD, associate professor of radiology At Weill Cornell Medicine, told Katie Couric Media in 2022. But the good news is that “the best thing we have found to decrease mortality, as well as morbidity, is undergoing annual screening mammograms starting at age 40 for average-risk women and doing it annually,” she adds.
The reason mammograms are important is that a doctor may catch a cancer at a small size, when it’s less likely to have spread. Furthermore, the prognosis for a woman with cancer that’s caught during screening is “significantly better” compared to that of someone who comes in presenting with cancer, Dr. Dodelzon said.
What happens at a mammogram?
Any clinician can put in a prescription for a mammogram, Dr. Dodelzon said, and from what she describes, the process is pretty straightforward. Once you get to the appointment, you may fill out a questionnaire that’s aimed at gathering more information that could point to additional risk factors or give context to the radiologist. After that, you’re escorted into a changing room, where you disrobe from the waist up and are given a gown. You shouldn’t wear deodorant on the day of the exam since many deodorants contain aluminum or other metallic substances that look like calcifications on a mammogram (which can be, but are not always, a sign of early cancer).
A technician will then help position the breast in the machine, which has a plate upon which the breast rests and a top paddle that compresses it. Then, two different views of each breast are taken, and the procedure takes about three minutes.
Who is at elevated risk for breast cancer?
Having a genetic predisposition to developing breast cancer — such as the BRCA gene — would put someone at higher risk, but there are other factors to be aware of, even though you cannot necessarily change them all. Dr. Dodelzon said that any woman whose first-degree relative (a parent, sibling, or sometimes child) developed premenopausal breast cancer before age 50 should get her first mammogram 10 years before their relative’s diagnosis. Additionally, women who received chest or breast radiation (for Hodgkin’s lymphoma treatment, for example) before age 30 are at higher risk. According to the CDC, getting your first period before age 12 and going through menopause after age 55 also increases the risk of breast cancer, since it exposes the body to hormones longer.
Additionally, Black women and women of Ashkenazi Jewish descent are more likely to develop breast cancer and should talk to their doctor to see if additional or early screening would be a good option for them.
That said, there are certain lifestyle risk factors you can control. The first way is to get up and get moving — the CDC states that lack of physical activity increases the risk of breast cancer. In addition, the more alcohol you drink, the more the risk increases.
Bottom line, getting a mammogram starting at age 40 is a crucial step in managing your breast cancer risk, and is not to be skipped.
