When Should You Get Your First Mammogram?

Illustration of woman getting a mammogram

Getty Images/KCM

The answer might surprise you.

You might have guessed that we’re big on preventative cancer screenings over here. From getting a colonoscopy to screening for prostate cancer, we’re firm believers in being proactive about your health — after all, it could literally save your life. And right now, breast cancer screenings are top of mind, given that October marks Breast Cancer Awareness Month. According to the American Cancer Society, with the exception of skin cancer, breast cancer is the most common type of cancer in women in the United States, making up 1 in 3 of all new cancers diagnosed in women each year. The American Cancer Society estimates that this year alone, over 287,000 new cases of invasive breast cancer will be diagnosed in women. Overall, there is a 1 in 8 chance a woman in the U.S. will develop breast cancer in her lifetime.

The good news is that breast cancer rates in women above age 50 have continued to decrease since 2007, which experts believe is because of increased awareness, better treatments, and catching it early thanks to mammograms. Here’s what you need to know about preventative breast cancer screening, including when you should get your first mammogram and what to expect at the appointment.

When should you get your first mammogram?

The United States Preventive Services Task Force (USPSTF), which offers official guidance for when and how we should get screened for cancer, has recently lowered the recommended age women of average risk should start getting routine mammograms to 40. This will have a hugely positive impact on women across the country — especially for women of color, who are 40 percent more likely to die from the disease than white women. The American College of Obstetricians and Gynecologists also recommends women of average risk get their first mammogram at age 40, and the ACOG and the American College of Radiology both recommend that all women be evaluated for their breast cancer risk by age 30. 

“Many medical societies, including the American Cancer Society, encourage women to have their risk of breast cancer assessed by their OB-GYN,” says Katerina Dodelzon, MD, associate professor of radiology At Weill Cornell Medicine. The assessment consists of a lengthy questionnaire that considers multiple family factors. “If that number is higher than 20 percent — the average woman is about 12 percent — potentially earlier screening or screening with additional modality like a breast MRI would be considered,” Dr. Dodelzon explains. 

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?

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 (vs. 69) results in a median increase in percent mortality reduction of 8% (range 7–11%) and 7% (6–10%) 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,” Dr. Dodelzon says. 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 says. 

What happens at a mammogram? 

Any clinician can put in a prescription for a mammogram, Dr. Dodelzon says, 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 says that any woman whose first-degree relative (a parent, sibling, or sometimes child) developed premenopausal breast cancer prior to 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.