At what age should a female undergo a mammography (mammogram) screening?

From the Guidelines

Women should begin regular mammogram screenings at age 40 and continue annually as long as they remain in overall good health and are willing to undergo the examination and subsequent testing or biopsy, if an abnormality is identified. This recommendation is based on the most recent evidence from the American College of Radiology (ACR) Appropriateness Criteria for female breast cancer screening, which suggests that annual screening mammography in women 40 to 84 years of age decreases mortality by 40% 1. The ACR recommends annual screening mammography beginning no later than 40 years of age for women at intermediate risk, and women should continue screening mammography as long as they remain in overall good health and are willing to undergo the examination and subsequent testing or biopsy, if an abnormality is identified 1.

Some key points to consider when determining the appropriate screening schedule include:

• Women with high-risk factors, such as a strong family history of breast cancer, genetic mutations like BRCA1 or BRCA2, or previous chest radiation therapy, should start screening earlier, typically around age 30, or 10 years before the youngest breast cancer diagnosis in their family 1.
• Non-Hispanic Black, Hispanic Black, and Hispanic White women have higher breast cancer mortality than non-Hispanic White women, and minority women often present at younger ages with more aggressive tumor subtypes, so decreasing access to screening mammography may disproportionately impact these groups 1.
• Annual screening mammography results in a greater reduction in mortality compared to biennial screening, with a 40% reduction in mortality in women 40 to 84 years of age, compared to a 32% reduction for biennial screening 1.
• The sensitivity of mammography is decreased in some groups of women, including those with dense breasts, and dense breast tissue decreases the sensitivity of mammography and is an independent risk factor for developing breast cancer 1.

Overall, the benefits of early detection and annual screening outweigh concerns about false positives or unnecessary biopsies, and women should discuss their personal risk factors with their healthcare provider to determine the most appropriate screening schedule 1.

From the Research

Screening Guidelines for Breast Cancer

The decision on when to get a mammogram depends on various factors, including the woman's risk level for breast cancer.

• For women at average risk, the evidence suggests that screening with mammography is most effective for women over 50 years old 2.
• For women at high risk, such as those with a family history of breast cancer or genetic mutations like BRCA1 or BRCA2, screening with mammography and magnetic resonance imaging (MRI) may be recommended at a younger age, typically starting at 25 years old 3, 4.
• The American College of Radiology and the Society of Breast Imaging recommend that women at high risk for breast cancer should undergo annual screening MRI in addition to annual mammography 5.

Radiation Exposure and Risks

It's also important to consider the risks associated with radiation exposure from mammography and other breast imaging techniques.

• A study found that the cumulative cancer incidence and mortality attributed to digital mammography were significantly lower than those associated with molecular breast imaging (MBI), breast-specific gamma imaging (BSGI), and positron emission mammography (PEM) 6.
• However, the benefit-risk ratio for annual digital mammography was found to be greater than 50:1 for women screened between 50-80 years old, indicating that the benefits of screening outweigh the risks 6.

Screening Modalities

Different screening modalities have varying levels of sensitivity and specificity.

• Digital mammography (DM) has been shown to be more sensitive than film mammography (FM) in screening asymptomatic women under 50 years old, particularly those with dense breast tissue 2.
• MRI has been found to be the most sensitive modality for breast cancer detection, but its specificity is lower than that of mammography 5.