Your Guide to 2023's Newly Revised Breast Cancer Screening Recommendations
At what age should we be getting our first mammograms? 40? 45? 50? How often do we need them? Does it really make a difference?
The short answer is 40, yearly, and yes, it could be lifesaving.
If you find the changing breast cancer screening guidelines confusing, you’re not alone. I’m a Physician Assistant with fifteen years of experience, primarily in women’s health, and I find them confusing, too. Let’s figure it out together.
We know that approximately 1 in 8 women in the U.S. will be diagnosed with breast cancer in their lifetime. Aging is a significant risk factor, as most breast cancers are found in women who are over fifty, with a median age of 63, and the largest cohort being women over 70.
According to the National Cancer Institute, data shows the odds of receiving a breast cancer diagnosis in the next ten years, starting at these ages, is broken down like this:
· Age 30 . . . . . . 1 in 204
· Age 40 . . . . . . 1 in 65
· Age 50 . . . . . . 1 in 42
· Age 60 . . . . . . 1 in 28
· Age 70 . . . . . . 1 in 24
Please note that, “These risks are averages for the whole population. An individual woman’s breast cancer risk may be higher or lower depending on known factors, as well as on factors that are not yet fully understood. To calculate an individual woman’s estimated breast cancer risk, health professionals can use the Breast Cancer Risk Assessment Tool, which takes into account several known breast cancer risk factors.”
In addition to age, race is also a critical risk factor, with Black and Indigenous women being prone to earlier and more aggressive cancers, and 99% of breast cancers are found in biological females.
Mammograms are the primary imaging tool we use to diagnose breast cancer. We also use ultrasound and MRI technology, but mammography is the most common and universal screening technique. These x-ray images of the breasts have been widely used here since the mid 1970s and for decades, the recommendation was to begin annual mammogram screenings at age 40. In the last decade, 3-D mammography has become more widely available, making digital composition of the x-ray images, and allowing for more accurate readings and fewer missed tumors than ever before.
In 2009, The U.S. Preventative Services Task Force, declared that universal breast screening with mammogram should begin, not at 40, but at age 50. From 2009 until just this week, it advised “women to start mammograms at 50, and for women ages 40-49 to consider it, depending on personal risk.” It read that regular screening before age 50 did “more harm than good, leading to unnecessary treatment in younger women, including biopsies that turn out to be negative.” The intention was to reduce the “harm through false-positive test results and overdiagnosis of biologically indolent lesions.”
The USPSTF has been around since 1984, consisting of national experts in prevention and evidence-based medicine; experts in internal medicine, family medicine, pediatrics, behavioral health, obstetrics and gynecology, and nursing. Their recommendations are given to congress, which means that they have great potential impact on public health policy. Their recommendations “are based on a rigorous review of existing peer-reviewed evidence and are intended to help primary care clinicians and patients decide together whether a preventive service is right for a patient's needs.”
The reaction to the task force’s 2009 recommended change was divided. Some saw a physical, emotional, and financial advantage to both patients and the system of waiting to initiate regular screening until later in life. Those in women’s’ health and oncology who have treated countless women in their forties, feared that, if the new guidelines were followed, those tumors wouldn’t be identified until they were in more advanced, hard-to-treat stages. The American Cancer Society decided that women 40 to 44 who are at "average" risk should "have the option" to start screening,” and that all women should start having annual mammograms at 45. Other groups never varied from the original guidelines of starting at age 40. This means that patients were getting different advice and facing different obstacles with access to mammograms depending on where they lived, who their providers were, and what school of thought they followed.
As of May 8, 2023, the task force has reversed its recommendations, based on data showing an increase in cancer diagnoses in women between the ages of 40 and 50. It now recommends “all women to get screened every other year, starting at age 40.”
As per the May 8, 2023 New York Time’s report, this drastic change comes from, “troubling trends in breast cancer in recent years. They include an apparent increase in the number of cancers diagnosed in women under 50 and a failure to narrow the survival gap for younger Black women, who die of breast cancer at twice the rate of white women of the same age.”
“We don’t really know why there has been an increase in breast cancer among women in their 40s,” said Dr. Carol Mangione, immediate past chair of the task force and co-author of the new recommendation. “The evidence has shifted in support of recommending mammograms for all women at 40.”
Ideally, this will clarify and universalize public health efforts for breast cancer screening, and we will catch more cancers in their early stages. There is hope that finally the disparities Black women face in screening and care are being addressed and we continue to see new improved methods of early detection and more effective, less traumatic treatments for breast cancer.
Sarah Zimmerman is a freelance writer in Northern California and is working on her first novel. In past lives,, she has been a Physician Assistant in Women's Health and the owner of a vegan ice cream business. Sarah writes about marriage, sex, parenting, infertility, pregnancy loss, social justice, and women's mental and physical health, always with honesty and humor. She has written for Ravishly, Cafe Mom, Pregnant Chicken, and more and can be found at sarahzwriter.com and on Medium, Twitter, Facebook, Instagram and TikTok at @sarahzwriter.