You’ve probably heard it before—women should start getting mammograms every year starting at age 40. It’s been the standard for years—that is, until the U.S. Preventive Services Task Force (USPSTF) introduced revised recommendations that bumped up the age to 50.
Confused? You’re not the only one. In fact, not all medical professionals and leading cancer groups agree with the new recommendations. Despite the different advice out there about breast screening, we can help break down what you need to know.
Here’s the first thing: Breast cancer doesn’t always have symptoms, such as feeling a lump in your breast. That’s why screening is important to help detect cancer early, when it’s highly treatable.
Susan Holley, MD, PhD, a breast imaging radiologist at Wake Radiology, recommends starting mammograms at age 40 for women at average risk (meaning no strong family history of breast cancer or other genetic risk factors) and repeating them annually.
Susan Holley, MD, PhD, a breast imaging radiologist at Wake Radiology, recommends starting mammograms at age 40 for women at average risk (meaning no strong family history of breast cancer or other genetic risk factors) and repeating them annually. Dr. Holley says evidence shows that annual screening starting at age 40 finds the most cancer and saves the most lives.
Dr. Holley’s advice is in line with the American College of Radiology, the Society of Breast Imaging and the National Comprehensive Cancer Network. But not all leading medical groups give the same advice; in addition to the USPSTF’s advice to start at age 50 and return every two years, the American Cancer Society recommends annual mammograms starting at age 45. However, both agree that women should start mammograms at age 40 if they wish.
So why start later? The concern stems from the stress and inconvenience mammograms can cause, whether it’s having to come back for additional imaging tests or undergoing a biopsy (removing and examining tissue from the body) that may ultimately result in nothing. According to Dr. Holley, there’s also a risk of finding something that might be cancer but would never have grown and caused a problem. However, when you account for these negatives and the potential positives—like finding a malignancy early—most women opt to get screened.
“We don’t have a crystal ball to know which cancers progress and which do not,” Dr. Holley says.
Here’s what to know about the different breast screening types.
The most effective breast cancer screening is a mammogram, an X-ray that allows the radiologist to look at breast tissue. Even before you feel any symptoms, including lumps in your breast, mammograms can detect the early stages of breast cancer. More specifically, mammograms can detect masses and deposits of calcium that may be an early sign of cancer. A mammogram uses two plates to compress the breast so the X-rays can reach all the breast tissue.
A 3-D mammogram is more sensitive and takes multiple images of the breast tissue at different angles, allowing radiologists to better see potentially suspicious areas.
A so-called 3-D mammogram (or “tomosynthesis” exam) may be used in addition to a standard 2-D mammogram, to take more detailed images of breast tissue. A 3-D mammogram is more sensitive and takes multiple images of the breast tissue at different angles, allowing radiologists to better see potentially suspicious areas.
Sometimes, if a screening mammogram finds an area of concern, the doctor will order a follow-up diagnostic mammogram and a breast ultrasound. For younger women with denser breasts, ultrasound is often used first to follow up on a palpable lump.
Breast Magnetic Resonance Imaging (MRI)
If you are at high risk of breast cancer, your physician may suggest a breast MRI. Instead of radiation, a breast MRI uses magnets and intravenous contrast to obtain information about the breast tissue that may not be seen with other screening tests. However, this goes both ways: An MRI can miss cancers that a mammogram will pick up, so MRI should be used in addition to a mammogram. Breast MRI can also result in false positives, which means more tests need to be conducted to ensure that a finding is benign (not cancer). This is why screening breast MRI is not recommended for women at average risk of breast cancer.
Breast Self-Exams and Clinical Exams
The American Cancer Society does not recommend clinical breast exams or self-exams because research shows there’s no clear benefit of either to help find breast cancer early. However, Dr. Holley says you should still be familiar with how your breasts normally feel and report any changes to your primary care physician. It’s each woman’s choice whether to do a self-exam; some women find cancers this way. But the point of mammogram screening is to find cancers before you can feel them.
The Best Plan
Annual screening mammography beginning at age 40 is the best tool to detect breast cancer early. Depending on your family history and genetic risk factors, your primary care physician may recommend you get screened earlier. Screening can be inconvenient or stressful, but it may also save your life.