Screening mammogram guidelines change; screenings should begin at age 40

Women should begin getting mammograms at the age of 40, an updated recommendation from older guidelines recommending mammograms begin at age 50. The guidelines changed in part because of the rising rates of breast cancer among younger women and Black women.

The latest data, which span 2015 to 2019, show a 2 percent increase in breast cancer diagnoses per year among women in their 40s. The U.S. Preventative Services Task Force revised the recommendations earlier this year.

Why were the guidelines updated?

Screening starting at age 40 has the potential to save about 20 percent more lives from breast cancer among all women. Researchers believe the change will also save the lives of more Black women, who have the highest death rate from breast cancer.

“This update addresses the disturbing trend we’re seeing with a younger population of patients being diagnosed with breast cancer,” says Dr. John Plemmons, a radiologist with Medical Center Radiologists. “Black women are also 40 percent more likely to die from breast cancer and often get aggressive cancers at young ages. This is a vital first step to address this health inequity.”

The updated recommendations call for more research to address health disparities across screening and treatment experienced by Black, Hispanic, Latina, Asian, Pacific Islander, Native American and Alaska Native women.

Who is included in this recommendation?

The recommendation applies to cisgender women and other people assigned female at birth who are 40 years and older. It includes women at average risk of breast cancer, as well as those with a family history of breast cancer and those with dense breasts.

The recommendation does not apply to people who:

• Have a personal history of breast cancer
• Are at very high risk of breast cancer due to certain genetic markers or a history of high-dose radiation therapy to their chest at a young age
• Have had a lesion on previous biopsies

These women should consult their healthcare professional for guidance about screening.

Does this new recommendation change what will be covered by insurance?

No. Currently, most insurance companies are legally required to cover mammograms every year, starting at age 40, for women who want them.

Screenings for the uninsured

Uninsured women may be eligible for free screenings through public health programs. Every Woman’s Life (EWL) is a public health program for Virginia residents that helps uninsured, low-income women access free breast and cervical cancer screening services. The North Carolina Breast and Cervical Cancer Control Program (NC BCCCP) provides free or low-cost breast and cervical cancer screenings and follow-up to eligible women in North Carolina.

Guidance for women with dense breasts?

Nearly half of all women have dense breasts, which increases their risk for breast cancer and means that mammograms may not work as well for them. Women are generally told that they have dense breasts after they’ve had a mammogram. The task force responsible for updating the mammogram guidelines also recommends more research on whether and how additional screenings, such as breast ultrasound or MRI, may help women with dense breasts find cancers earlier.

Making sense of multiple guidelines

Several large national organizations issue the cancer screening guidelines. This includes the U.S. Preventive Services Task Force (USPSTF), which published the guidelines recently updated, and the American Cancer Society. Other groups also regularly issue and update cancer screening guidelines.

“Unfortunately, these guidelines don’t always agree,” explains Plemmons. “This latest update means most organizations are now in agreement, recommending that mammography screening start at age 40 for women at average risk.”

Sentara's screening guidelines

The Sentara Cancer Network's current guidelines for screening a person at average risk for breast cancer are:

• Beginning at age 40, all people assigned female at birth should have annual mammograms after an informed decision with their health care provider, based on personal and family history.
• Screening should continue provided the individual is in good health and expected to live 10 years or longer.

Make an appointment with your provider to discuss the recommendations and what they mean for you.