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According to an influential US task force, regular mammograms for breast cancer screening should begin at the age of 40. Women ages 40 to 74 should get tested every other year, the group said.
Earlier, the task force said women could choose to start breast cancer screening at age 40, with a stronger recommendation that they get screened every two years from age 50 to 74.
The announcement Tuesday from the US Preventive Services Task Force makes official a draft recommendation announced last year. The recommendations were published in the Journal of the American Medical Association.
Also read: Why are young women getting breast cancer?
“It’s a win that they’re now recognizing the benefits of screening women over the age of 40,” said Dr. Therese Bevers of MD Anderson Cancer Center in Houston. She was not involved in the guidance.
Other medical groups, including the American College of Radiology and the American Cancer Society, suggest getting mammograms every year rather than every other year, starting at age 40 or 45, which may cause confusion, Bevers said. “Now the starting age will align with what many other organizations are saying.”
Death rates from breast cancer have declined as treatment continues to improve. But breast cancer is still the second most common cause of cancer death among American women. Approximately 240,000 cases are diagnosed annually and approximately 43,000 women die from breast cancer.
The push toward early screening is meant to address two complex issues: the rising incidence of breast cancer among women over age 40 — it has increased by 2% annually since 2015 — and the higher incidence among black women compared with white women. The death rate from breast cancer is high in the U.S., said Dr. John Wong, force vice chairman of Tufts Medical Center in Boston.
“Sadly, we know very well that black women are 40% more likely to die from breast cancer than white women,” Wong said. Modeling studies estimate that early screening could help all women, and “there would be even greater benefits for women who are black,” he said.
Here are more details about what’s changed, why it’s important, and who should pay attention.
When should I get my first mammogram?
Age 40 is the time when mammograms should be started for average-risk women, transgender men, and non-binary people. According to the new guidance, they should have an X-ray exam every other year. Other groups recommend annual mammograms starting at age 40 or 45.
This advice does not apply to women who have had breast cancer or who are at very high risk of breast cancer because of genetic markers. It also does not apply to women who had high-dose radiation therapy to their chest when they were younger, or women who had a lesion on a previous biopsy.
What about women 75 and older?
It is unclear whether older women should continue to have regular mammograms. Studies have rarely included women age 75 and older, so the task force is calling for more research.
Bevers suggests that older women talk to their doctors about the benefits of screening as well as the harms, such as false alarms and unnecessary biopsies.
What about women with dense breasts?
Mammograms don’t work as well for women with dense breasts, but they should still get screened.
The task force would like to see more evidence about additional tests, such as ultrasound or MRI, for women with dense breasts. It’s not yet clear whether these types of tests will help detect cancer at an earlier, more treatable stage, Wong said.
Does this affect insurance coverage?
Congress has already passed legislation requiring insurers to pay for mammograms for women age 40 and older with no copayments or deductibles. In addition, the Affordable Care Act requires insurers to honor the task force’s recommendations with coverage with an “A” or “B” letter grade. The mammography recommendation has a “B” grade, meaning it has a moderate net benefit.
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