At what age should women start getting mammograms (mammography)?

Mammography Screening Age Recommendations

Women with average risk of breast cancer should begin regular mammography screening at age 45, with annual screening from ages 45-54 and biennial screening at age 55 and older, as recommended by the American Cancer Society. 1, 2

Current Guideline Recommendations

The recommendations for mammography screening have evolved over time:

• American Cancer Society (2015):

  • Begin at age 45 (Strong Recommendation)
  • Annual screening ages 45-54 (Qualified Recommendation)
  • Biennial screening at age 55+ with option to continue annually (Qualified Recommendation)
  • Option to begin annual screening between ages 40-44 (Qualified Recommendation) 1

• American College of Radiology:

  • Annual screening beginning at age 40 2, 3

• Earlier ACS Guidelines (1997-2012):

  • Previously recommended annual mammography beginning at age 40 1

Risk-Based Screening Considerations

Risk assessment should guide screening decisions:

• Average risk is defined as women without:

  • Personal history of breast cancer
  • Suspected or confirmed genetic mutation
  • History of chest radiation at a young age 2

• Higher risk women require earlier and/or more intensive screening:

  • Women with genetics-based increased risk
  • Calculated lifetime risk ≥20%
  • Chest radiation exposure at young ages 2, 3
  • Family history of breast cancer (consider starting 10 years before youngest diagnosis in family, but not before age 30) 2, 4

Benefits of Mammography Screening

• Earlier detection allows for less invasive treatment options
• Reduces breast cancer mortality
• For women screened biennially starting at age 50, approximately 7 fewer breast cancer deaths per 1000 women screened 2

Potential Harms of Screening

• False-positive results leading to additional testing and anxiety
• Overdiagnosis of cancers that may not have become clinically significant
• For women screened biennially starting at age 50, approximately:
  • 953 false-positive results
  • 146 unnecessary biopsies
  • 19 overdiagnosed cancer cases per 1000 women screened 2

Screening Frequency

• Ages 45-54: Annual screening provides greater mortality reduction 1, 2
• Age 55+: Transition to biennial screening or continue annual screening based on individual preference 1, 2

Duration of Screening

• Continue screening as long as overall health is good and life expectancy is at least 10 years 1, 2
• No specific upper age limit for discontinuation; decision should be based on health status and life expectancy 2

Clinical Breast Examination

• The American Cancer Society does not recommend clinical breast examination for breast cancer screening among average-risk women at any age 1, 2

Special Considerations

• Women with dense breasts may benefit from supplemental screening 2
• Digital breast tomosynthesis (DBT) may improve cancer detection rates and decrease false-positive recalls, particularly for women with dense breasts or under age 50 2

The most recent and highest quality evidence supports beginning mammography at age 45 for average-risk women, with the option to start at age 40 based on individual risk assessment and preferences. This recommendation balances the benefits of mortality reduction against potential harms of false positives and overdiagnosis.