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When Should You Get Your First Mammogram?

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When Should You Get Your First Mammogram?

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Breast cancer is the second leading cause of cancer death among women, according to the American Cancer Society. In fact, 42,000 women and 500 men in the US die each year from breast cancer, per the Centers for Disease Control and Prevention (CDC). And Black women are 40 percent more likely to die from breast cancer than white women, according to the American Cancer Society.

Breast cancer screenings can be crucial in detecting breast cancer early on, and mammograms are the most common screening test. The examination involves using a low-dose X-ray performed by radiologists to look for changes and abnormalities in breast tissue that may signal cancer.

While the procedure may be a tad uncomfortable, it shouldn’t hurt. And ultimately, the benefits outweigh the temporary discomfort, as research has shown that mammography has helped reduce breast cancer mortality in the US by nearly 40 percent since 1990, making it a critical preventative measure.

But since breast cancer screening guidelines are ever-changing — the United States Preventive Services Task Force (USPSTF) just announced new guidelines on April 30 — you may be confused about when is the right time to go in for your first official mammogram. Here’s what to know.

When Should You Get a Mammogram?

According to the latest USPSTF guidelines, women and those assigned female at birth should be screened for breast cancer every other year starting at age 40 through age 74. This decision comes after May 2023 USPSTF draft recommendations introducing the change. Previously, it was recommended that breast cancer screenings begin at age 50 and those under 50 could discuss getting screened with their healthcare provider.

What’s the Impact of the Latest Mammogram Guidelines?

“Lowering the age for initial screening to 40 years is critical as approximately 60,000 breast cancers are diagnosed each year in women under 50,” says Stacy Smith-Foley, MD, medical director of the Breast Center at CARTI, an Arkansas-based cancer clinic.

“Additionally, the change helps to address disparities in breast cancer outcomes. Black women are more likely than any other group to be diagnosed with breast cancer under the age of 40 and have a 40 percent higher mortality rate compared to white women,” Dr. Smith-Foley points out. “Lowering the age for initial screening helps better address the needs of this group.”

But Dr. Smith-Foley also believes that, in other ways, the USPSTF guidelines don’t go far enough. And the team that makes up the Brem Foundation, which focuses on breast cancer early detection, agrees.

“Their guidelines fall short on several fronts — in not recommending annual screening, not effectively addressing existing disparities through risk assessment, and not recognizing the importance of additional screening beyond mammography for women with dense breasts,” the Brem Foundation says, in a statement released shortly after the new USPSTF guidelines.

“USPSTF missed the opportunity to call for an earlier risk assessment for Black women and other ethnic groups who are at increased risk,” the statement continues. In contrast, the American College of Radiology recommends that high-risk groups such as Black women and Ashkenazi Jewish women get risk assessments by age 25 to assess earlier mammography needs before age 40, something the Brem Foundation “strongly supports.”

Other concerns raised: “They failed to make additional recommendations that could further aid early detection, such as recommending women get screened annually or prioritize 3D mammography, a combination that has been shown to effectively aid earlier cancer detection,” Dr. Smith-Foley adds.

Those 75 and up are also left out of the conversation. According to the USPSTF, “current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women age 75 years or older.” Some research has shown has shown that getting mammograms over the age of 70 was more likely to result in a tumor diagnosis that otherwise poses no health threat. But Dr. Smith-Foley argues you can never be too careful.

“I have a collection of female patients with breast cancer in their 80s and 90s who stopped screening early and whose breast cancers weren’t diagnosed at earlier stages as a result. If you have breasts and birthdays, your risk of breast cancer continues,” she tells PS. In fact, she’s advised her own 75-year-old mother to get a mammogram yearly.

“The leading radiology groups (American College of Radiology and the Society of Breast Imaging) affirm this and recommend continued annual screening for women past age 75 unless severe comorbidities limit life expectancy,” Dr. Smith-Foley says. So if you or a loved one is in your mid-70s, it’s still worth having a conversation with a healthcare provider about your breast screening needs.

The bottom line: the USPSTF guidelines offer a decent starting place, but it’s essential to speak with your doctor about your own, individual risk factors (you can even consider asking about the breast cancer risk assessment score), and get a personalized recommendation based on those. If you have a strong family history of breast cancer or dense breasts, for instance, your doctor may recommend additional screenings — and they could be life saving.

— Additional reporting by Emilia Benton

Alexis Jones is the senior health editor at PS. Her areas of expertise include women’s health, mental health, racial and ethnic disparities in healthcare, diversity in wellness, and chronic conditions. Prior to joining PS, she was the senior editor at Health magazine. Her other bylines can be found at Women’s Health, Prevention, Marie Claire, and more.

Emilia Benton is a freelance health and wellness journalist who is particularly passionate about sharing diverse stories and elevating underrepresented voices. In addition to PS, her work has been published by Runner’s World, Women’s Health, Self, Outside, and the Houston Chronicle, among others. Emilia is also a 13-time marathoner and a USATF Level 1-certified run coach.

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