At what age is a mammogram (mammography) recommended?

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. 1

Age to Begin Screening

• The American Cancer Society (ACS) strongly recommends that women with average risk of breast cancer begin regular screening mammography at age 45 1
• Women should have the opportunity to begin annual screening between ages 40-44 if they choose to do so (qualified recommendation) 1
• The U.S. Preventive Services Task Force (USPSTF) recommends biennial screening mammography for women aged 50-74 years 1
• The American College of Obstetricians and Gynecologists recommends mammography every 1-2 years starting at age 40, and yearly after age 50 2
• The American Medical Association recommends mammography every 1-2 years in women ages 40-49 and annually beginning at age 50 2

Screening Frequency

• Women aged 45-54 years should be screened annually (qualified recommendation) 1
• Women aged 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation) 1
• Annual screening results in more screening-detected tumors, tumors of smaller sizes, and fewer interval cancers than longer screening intervals 3

Benefits of Mammography Screening

• Screening mammography has been proven effective in reducing breast cancer deaths in women age 40 years and older 3
• A mortality reduction of up to 40% is possible with regular screening 3
• Meta-analyses of randomized clinical trials show an 18-26% mortality reduction among women aged 40-49 years 1
• Screened women in their 40s are more likely to have early-stage disease, negative lymph nodes, and smaller tumors than unscreened women 3

When to Stop Screening

• Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or more 1
• The American College of Physicians recommends stopping screening in women aged 75 or older, or those with a life expectancy of less than 10 years 4
• No specific upper age limit is recommended for stopping screening if a woman is in good health 1

Special Considerations

• Women with genetic mutations such as BRCA1 and BRCA2, personal history of breast cancer, or history of chest radiation may require earlier and more frequent screening 2, 5
• Women with a family history of a first-degree relative with breast cancer at a young age may need screening before age 40 5
• Awareness of guidelines varies significantly among women, with only 20% of women aged 40-49 being aware of USPSTF screening guidelines 6

Potential Harms of Screening

• False-positive results may lead to additional testing and temporary anxiety 2, 7
• Recall and biopsy recommendations are higher with more frequent screening 3
• The increased density of breast tissue in younger women reduces the sensitivity of mammography (about 75% in women under 50 versus 85% in women over 50) 8
• Overdiagnosis is a potential risk, as screening may detect cancers that would not have become clinically significant 7

Conflicting Recommendations

• Different organizations have varying recommendations, creating confusion for both patients and providers 1
• The ACS recommends starting at age 45 with annual screening until age 54 1
• Older guidelines from the American Cancer Society (1997) recommended annual mammography beginning at age 40 1
• The USPSTF recommends biennial screening starting at age 50 1

Despite these variations, the most recent high-quality evidence supports beginning 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 in their 2015 guideline update 1.