The Society of Breast Imaging and the Breast Imaging Commission of the American College of Radiology recommend that women at average risk of breast cancer begin screening with mammography starting at the age of 40. These recommendations were published in the Journal of the American College of Radiology.

Mammograms (X-ray images of the breasts) are commonly used to screen women for breast cancer. The goal of screening mammography is to reduce breast cancer mortality by detecting breast cancer at an early stage.

The age at which mammographic screening should begin has recently been a subject of debate. The American Cancer Society continues to recommend that women at average risk of breast cancer begin mammographic screening at the age of 40.[1] The U.S. Preventive Services Task Force, however, recently recommended against routine mammographic screening of women in their 40s, noting that the decision to begin screening women in this age group “should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms.”[2] 

Two other groups that have recently added their voices to the discussion are the American College of Radiology and the Society of Breast Imaging.[3] These groups continue to recommend that women at average risk of breast cancer begin annual mammographic screening at the age of 40. The groups also note that women at high risk of breast cancer, such as those with certain BRCA1 or BRCA2 mutations, should begin screening at an earlier age, and should be screened with breast magnetic resonance imaging (MRI) in addition to mammography.

In light of the recent debate concerning when to begin screening mammography, women are encouraged to talk with their physician about the screening approach that’s right for them.

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11/17/09 - The U.S. Preventive Services Tasks Force (USPSTF) has reversed its position on screening mammography for women in their 40s: the group no longer recommends routine screening mammography for average-risk women in this age group.[1] The American Cancer Society, however, has stated that it will continue to recommend annual mammograms starting at the age of 40.[2]

How should women respond to this news? Calmly. There has always been debate about whether or not to recommend routine screening mammography for women in their 40s. The focus of the debate is the balance of risks and benefits. The most important potential benefit of screening mammography is a modest reduction in breast cancer mortality. Potential risks of mammography include false-positive test results (which lead to stress and additional testing), false-negative test results (a missed cancer), and overdiagnosis. Overdiagnosis refers to the diagnosis of a cancer that will never cause health problems during the life of a patient. Overdiagnosis leads to unnecessary cancer treatment.

For young women, the balance of risks and benefits is different than for older women, and may not clearly favor screening (although this point continues to be debated). Young women are more likely than older women to experience some of the downsides of mammographic screening, and are also less likely to have breast cancer.

That fact that the USPSTF and the American Cancer Society now have different screening recommendations for women in their 40s simply reinforces the importance of educating yourself about the potential risks and benefits of screening, talking with your physician, and making the decision that’s right for you. This point is highlighted by the USPSTF, which notes “The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms.”

The USPSTF statement is an update of its 2002 recommendations and is based on a review of the available data. Since 2002, new data have become available about mammography in younger women.

Other highlights of the new USPSTF recommendations include the following:

• For women between the ages of 50 and 74 years, the USPSTF recommends mammography every two years (rather than every year).
• The USPSTF notes that there is insufficient evidence to assess the benefit and harms of screening in women over the age of 74.
• The USPSTF recommends against teaching breast self-exam.

Although the USPSTF’s position on breast self exams may also be perceived as controversial, there has never been clear evidence that breast self-exams reduce breast cancer mortality.

It should be noted that the recent discussion regarding mammography recommendations is focused on women at average risk of breast cancer. Women at increased risk as a result of family or personal history may need to begin screening at a younger age, and may benefit from screening with breast magnetic resonance imaging (MRI) in addition to mammography. Women who have questions about the screening schedule and approach that’s right for them are advised to talk with their physician.

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