Are breast cancer screening guidelines changing? What to know

Experts agree that regular mammograms to screen for breast cancer are a key to early detection. But it may seem as if some experts and health care advocacy groups and agencies keep moving the goal posts on screening recommendations.

What age should you start getting routine mammograms? How often? When should you stop? And what else can you do to reduce your breast cancer risk?

In the last 30 years, screening guidelines have changed frequently and were often conflicting, depending on which organizations published them. Now a new draft recommendation expected to be finalized by the end of 2023 from the U.S. Preventative Task Force (USPTF), a federal panel of experts that issues guidelines about preventative care, may clear up some—but not all—of the confusion.

What are the proposed breast cancer screening guidelines?

For women at average risk, the new USPTF recommendation lowers the age to begin routine mammograms to age 40—10 years earlier than previous guidelines. The change is based on research showing the risk of breast cancer in younger women has been climbing. The National Cancer Institute reports that between 2016 and 2019 (the most recent data available) breast cancer rates increased nearly 3 percent annually in women under age 50.

How often should you get a mammogram?

If you’re at average risk, USPTF is now recommending mammograms every two years. However, this guidance differs from many agencies and cancer hospitals, most of which recommend annual screenings.

The USPTF guideline is important because the Affordable Care Act requires private insurers to cover with no copay all exams and procedures the panel recommends. Currently, insurers adhere to the USPTF’s 2002 recommendation, which covers mammograms annually. But, in 2025, that could change to every two years.

“Part of the difficulty is there are many different studies out there. Some studies are old, some used technology for screening that’s now outdated,” says Cynthia Lynch, MD, a Medical Oncologist at City of Hope Phoenix. “However, The American Cancer Society (ACS) and National Comprehensive Cancer Care Network (NCCN) indicate there’s enough data to show there’s a reduction in mortality when you screen on an annual basis versus every two years.

“At City of Hope, we recommend annual mammograms.” Dr. Lynch says.

Here are recommendations for screening mammograms from relevant agencies and organizations:

• USPTF: Currently 50, annually; new recommendation age 40, every two years

• American College of Obstetricians and Gynecology (ACOG): Age 40, annually

• American College of Radiology (ACR): Age 40, annually

• NCCN: Age 40, annually

• Society of Breast Imaging (SBI): Age 40, annually

• ACS: Ages 40 to 54, annually; ages 55 to 74, every two years.

These guidelines only apply to people assigned female at birth who are at average risk for breast cancer.

Dr. Johnson believes a one-size-fits-all approach to breast cancer screening is not ideal. “We know that [Black women] present at a much younger age,” she says. “The death rate for Black women is also 40 percent higher than all races, and ethnicities. We actually need personalized screening, including race-specific mammography criteria and guidelines based not just on age, but on risk factors.”

One research study— Women Informed to Screen Depending on Measures of risk (WISDOM)— is evaluating a personalized approach to breast cancer screening based on each woman’s risk as determined by individual risk factors for breast cancer, including breast density, genes and family health history.

While guidelines are helpful, it’s important to assess your individual breast cancer risk, based on your genetic profile, family history, lifestyle and other factors. Experts recommend asking your primary care doctor or gynecologist to conduct a personal risk assessment by age 30. If you’re at increased risk, your doctor may suggest earlier breast cancer screening, more frequent or intensive screening and medications to proactively reduce your risk.

A risk assessment is based on your age, reproductive history (such as when you started your period, if you gave birth and what age you gave birth) and other factors known to increase risk.

Establish a personal screening plan and stick to it: Schedule a doctor’s visit to discuss your breast cancer risk factors and make a personal mammogram screening plan. Getting regular mammograms enables your doctor to compare results over time and identify breast changes or abnormalities unique to your breasts. Mammograms are proven to identify breast cancer early, often before signs or symptoms occur, when its most treatable.

For more information visit cancercenter.com. Call 602.883.1463 today to schedule a screening.