Women Should Begin Regular Mammograms at 40, U.S. Health Panel Recommends

All women and people assigned female at birth should begin getting regular mammograms at age 40, the U.S. Preventive Services Task Force (USPSTF) proposed on Tuesday—10 years earlier than the current recommendations that breast cancer screenings begin at 50 years old.

The proposed new guidelines come in the form of draft recommendations from the USPSTF, a highly influential health panel whose recommendations are typically widely adopted in the United States. Although the draft recommendations are not final, it’s likely they will be approved in the future, after a period of public comment.

“This is great news for women. [It] will help to minimize the confusion about when women should start,” Therese Bevers, MD, medical director of the Cancer Prevention Center at the University of Texas MD Anderson Cancer Center, told Health in a statement.

Changing the recommended screening age from 50 to 40 for all women may be especially important in the context of racial disparities.

Black women have a 40% higher death rate from breast cancer as compared to White women, despite lower incidence rates. Research published last month went so far as to recommend a race-adjusted approach to breast cancer screening, recommending that Black women start screening at age 42 because of their elevated risk.

In its announcement the USPSTF also called for more research to address and remedy breast cancer health disparities, as well as more information on screening for older women and those with dense breasts.

Here’s what to know about the proposed updates to breast cancer screening recommendations.

New Age for First Mammogram—What Changed?

The current USPSTF guidelines—which were instated in 2016—recommend that all women at average risk of breast cancer begin getting mammograms at age 50. Mammograms are recommended every two years until the age of 74.

Under the current guidelines, women ages 40 to 49 are recommended to make an individual decision with their doctor about when to start mammography. This would depend on how the person weighed the pros of finding early breast cancer against the cons of a possible false positive or unnecessary biopsies.

The guidelines also state that women with a family history of breast cancer may benefit more than average-risk women in beginning screening in their 40s.

The new draft recommendations change the overall starting age of mammography, suggesting that all women and people assigned female at birth at average risk begin regular biennial mammograms at age 40 to screen for breast cancer.

According to Wanda Nicholson, MD, MBA, MPH, USPSTF vice-chair and senior associate dean for diversity and inclusion at the George Washington School of Public Health, new evidence compelled the health panel to change the overall recommended age of first screening.

“More women than ever before, between the ages of 40 to 49, are being diagnosed with breast cancer,” Dr. Nicholson told Health.

Looking at national databases, the USPSTF saw that breast cancer diagnoses for women ages 40 to 49 have been increasing since 2015, Dr. Nicholson explained. More data from the National Cancer Institute inputted into models also helped USPSTF members come to the conclusion that the recommendations needed to change.

“The task force regularly updates our recommendations. And we know that science evolves, treatments evolve, and so our recommendation statements can also evolve as well—that’s what you see here,” Dr. Nicholson said. “All women should begin screening with mammography at age 40 and continue until age 74.”

Potential Impact of Beginning Breast Cancer Screening Earlier

For women in the U.S., breast cancer is the second most common type of cancer, and the second most common cause of cancer death. In 2022 alone, just over 43,000 women died of breast cancer.

Compared to the current biennial mammogram recommendations for women ages 50 to 74, changing the starting age to 40 could prevent 1.3 additional breast cancer deaths per 1,000 women. For Black women, even more deaths may be prevented—earlier screenings could avert an additional 1.8 deaths per 1,000 women.

“Starting screening mammogram at age 40 will ensure that African American women, who often get breast cancer at an earlier age, will be diagnosed at an early stage and be less likely to die from the disease,” said Dr. Bevers.

Implementing these new screening recommendations is expected to help save 19% more lives generally speaking, but for Black women in particular, the impact could be as high as 24%, Dr. Nicholson said, adding that while screening won’t completely solve the breast cancer mortality gap, it could hopefully help to lessen it.

To that end, the panel also said that more research is needed to address the higher rates of breast cancer mortality among Black women to further understand the causes of the increased mortality risk, as well as why Black women are more likely to be diagnosed with breast cancers that lead to poorer health outcomes.

What About Annual Screenings, Dense Breasts, and Women Over 75?

Though the impact of screening earlier should help save women’s lives from breast cancer mortality, there are still a number of questions about breast cancer screening.

For one, the USPSTF recommends that women get mammograms once every other year, whereas other groups advocate for annual screenings.

But according to Dr. Nicholson, there isn’t yet any compelling data that shows that annual is more beneficial than biennial screening. Though there’s more opportunity to catch cancer, there’s also a higher risk of false positives and unnecessary treatment, she said.

The USPSTF also said in its statement that more information is needed about breast cancer screening for women with dense breasts and women over 75.

People with more dense breast tissue are at a higher risk of developing breast cancer, and mammograms are less effective screening methods for them. The USPSTF just didn’t have enough evidence to make a firm recommendation at this time, Dr. Nicholson said, but it’s possible that women with dense breasts may need mammograms in addition to other screening tests, such as an MRI or ultrasound.

Also, the USPSTF recommends that women over the age of 75 do not need to get screened for breast cancer, because there’s insufficient evidence as to the possible harm and benefits for this older population, Dr. Nicholson said. In Dr. Bevers’ opinion, however, women through the age of 79 should be getting screened.

For these two areas, as well as for people who might have an elevated risk of breast cancer due to genetic or other factors, it’s always best to speak with a healthcare provider about when to start and stop breast cancer screening, Dr. Nicholson added.

“Mammograms save lives,” she said. “We’ve known that for decades now, but [it’s] worth repeating today.”