14.06.2024

New Mammogram Advice: What to Know

The U.S. Preventive Services Task Force, a panel of experts that issues guidelines about preventive care, has recommended all women start routine breast cancer screening at 40, instead of at 50, the previous recommendation.

The panel continues to advise spacing the screenings at two-year intervals, although some other medical organizations endorse annual mammograms.

Who is affected by the new guidelines?

The advice applies to all “cisgender women and other people assigned female at birth” who are at average risk for breast cancer and do not have any troubling symptoms that might indicate breast cancer. This group includes women with dense breast tissue and a family history of breast cancer.

The recommendation does not apply to anyone who has already had breast cancer, has genetic mutations that increase breast cancer risk, has received high-dose radiation to the chest, or has had breast lesions identified in previous biopsies.

Why did the task force change its advice?

The panel based its advice on recent, more inclusive science about breast cancer in women under 50. Although no new clinical trial data were available — and only one older trial included a significant proportion of Black women — the panel commissioned a review of screening strategies and modeling studies to come to its conclusions.

The experts also took into account high death rates among Black women. Those diagnosed with breast cancer in their 40s have twice the mortality rate of white women.

Why not yearly mammograms?

When the task force makes recommendations, it tries to balance the benefits of mammography — lives saved — with the potential harms. Those include false-positive results that cause anxiety and lead to additional testing and invasive procedures, as well as overdiagnosis — the possibility that women will be subjected to treatment for “indolent” tumors that are slow-growing and would never become life-threatening. Mammograms also expose the breasts to radiation.

Mammograms save lives, but the panel’s research found no benefit to annual mammograms over biennial scans. Annual mammograms were no better at detecting Stage 2 cancers and other dangerous tumors, they concluded. Modeling studies estimated that biennial screenings offered a better benefit-to-harm ratio.

Will my insurance cover this?

Insurance companies are already legally required to fully cover mammograms every year for women who want them. This recommendation will not change that.

Will starting screening earlier save lives?

The task force’s review of screening strategies indicated the change could increase the survival rate by almost 20 percent. Over all, biennial screening starting at 40 and continuing until age 74 will avert 1.3 additional breast cancer deaths per 1,000 women, compared with screening that starts at 50.

The benefits may be even greater for Black women: an additional 1.8 breast cancer deaths averted per 1,000 women, according to the panel’s report.

When can I stop screening?

Women should continue screening until age 74. After that, it’s not clear, because there is no data on women 75 and over. The consensus seems to be that if a woman is in good health and has a life expectancy of at least another 10 years, she should continue receiving mammograms.

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