Do you know at what age you should start taking annuals? mammograms? Although this month is full of reminders to schedule your screening, the rules for when you should start making mammograms a part of your annual medical checklist are incredibly vague. If you ask three different doctors when you should start, you may encounter three different answers.

Let’s briefly summarize the current recommendations of three influential medical groups:

• American College of Radiology (ACR) recommends that women talk to their doctors about their risk of breast cancer by age 25 and get a mammogram every year starting at age 40 if they are at average risk.
• American Cancer Society Meanwhile, the (ACS) says that women at average risk “have the option to begin screening with a mammogram every year” between ages 40 and 44, should have annual screenings from ages 45 to 54, and should have screenings every two years starting at age 25. age 55.
• And US Preventive Services Task Force (USPSTF) now recommends that women get a mammogram every two years between the ages of 40 and 74.

The USPSTF’s current recommendation is actually a striking change from 2009 guidelines that encouraged women to begin biennial screening at age 50. This independent task force is appointed by the secretary of the U.S. Department of Health and Human Services, and its guidelines help determine what many insurers will do. It will cover, he says. Dorraya El-AshryPhD, chief scientific officer of the Breast Cancer Research Foundation.

All of this conflicting advice is confusing for providers as well as patients. “They left the American public scratching their heads,” he says Elisa PortMD, chief of thoracic surgery and director of the Dubin Breast Center at Mount Sinai Hospital in New York City.

But there’s one thing everyone agrees on: As research continues to show that breast cancer is on the rise in young women, screenings for Millennials and Generation Z need to start earlier than for previous generations. ACS in October 2024 to work found that breast cancer rates increased by about 1 percent each year between 2012 and 2021; But these rates increased faster for women ages 20 to 49; at a rate of about 1.4 percent per year over the same period.

So what’s a woman to do? When went through all the confusing rules and asked the experts.

Why is there so much confusion about mammograms?

To start, there are many different organizations that provide testing guidelines. El-Ashry, ACR, ACS and USPSTF to name just a few; The Breast Imaging Association, the American College of Physicians and the American College of Obstetricians and Gynecologists also have their own guidelines, he says.

But the main recommendations come from the USPSTF. El-Ashry says this is the driving force behind guidelines issued by government agencies such as the FDA and CDC.

USPSTF chief says USPSTF constantly scans medical literature to see if its recommendations need updating Wanda K. NicholsonMD, MPH. Ultimately, she decided to lower the recommended starting age to 40 based on new data on mammography screening and results in black women, updated models, and epidemiological trends showing an increase in breast cancer in women ages 40 to 45.

The task force also recommends getting a mammogram every two years rather than every year, unlike the ACR and ACS guidelines. Dr. “When you moved from biennial screening to annual screening, you had up to 50 percent more false positive results,” says Nicholson. She adds that this advice also includes women with risk factors such as a family history of breast cancer or dense breast tissue.

But other groups and individual providers looked at the same research and came to a different conclusion. For example, the ACR emphasizes that the current increase in breast cancer is at age 40 and recommends starting mammography at that age, he says. Stamatia DestounisMD, chair of the ACR’s breast imaging committee. Annual screenings are important, he says, because “there’s a long enough window to detect a change, but not a long enough window to allow something to grow and progress.”

How can I find out if I’m at higher risk for breast cancer?

Dr. Starting around age 25, Port suggests that women should undergo genetic testing with a geneticist or genetic counselor to see if they have BRCA1, BRCA2, or any other disease-causing mutation that increases the risk of breast cancer. A positive result for a number of different gene mutations would immediately place them in the high-risk category.

They should then have an evaluation by their PCP or obstetrician to analyze their risk.

During this evaluation, the doctor may use an online tool that estimates breast cancer risk. Breast Cancer Risk Assessment ToolAlso known as the Gail model Tyrer-Cuzick Risk Assessment CalculatorIt is also called the IBIS model. He says the IBIS model is “the most accurate of many existing risk models” Wendy BergMD, PhD, professor of radiology at the University of Pittsburgh School of Medicine and UPMC Magee-Womens Hospital.

Dr. Destounis says that although these tools are publicly available, they should be used with a doctor because the results can be difficult to understand.

Factors linked to a higher risk of breast cancer include:

• Having your first period at an early age or entering menopause at a late age
• Never having been pregnant or having had a pregnancy at an older age
• BRCA1 or BRCA2 genetic mutation or another disease-causing genetic variant that puts you at higher risk of breast cancer
• Being a first-degree relative (parent, sibling, or child) of someone with the disease-causing genetic variant
• Personal history of invasive breast cancer or ductal carcinoma in situ (DCIS)
• Personal history of lobular carcinoma in situ (LCIS) or atypical hyperplasia
• Radiation therapy to the chest area between the ages of 10-30
• Li-Fraumeni syndrome or Cowden/PTEN syndrome (or a first-degree relative with either syndrome)
• More than 20 percent lifetime risk of breast cancer, according to one risk model
• dense breast tissue

When should I get a mammogram?

If You Are At Average Risk

If your doctor determines that you are at average risk, experts recommend starting at age 40, but there is disagreement about whether you should get a mammogram every year or every two years.

Recommendations also vary on when you should stop regular testing. While the USPSTF says mammography should continue until age 74, many other organizations say mammography should be stopped when life expectancy is less than 10 years or when your doctor decides it’s a good time to end regular screening.

So what should women do? El-Ashry says to check with their doctor about the best time to start and end regular mammograms.

Dr. “There is no one-size-fits-all solution,” Port says. “This part needs to be personalized.”

If You Are At High Risk

Once the doctor determines that you are at high risk, Dr. Berg says you need to find a high-risk program in your area; You can ask for a referral from your breast imaging radiologist. Many major cancer centers have programs, such as the Mount Sinai Dubin Breast Center in New York City or UCLA’s High-Risk Breast Clinic in Santa Monica, California. specially designed for high risk patients.

The program then talks with you about prevention options (for example, medication or surgery) and when to start mammography, Dr. Port. The doctor will then schedule any necessary follow-up appointments (such as an annual MRI as well as a mammogram), he adds.

Dr. “We do all the behind-the-scenes work,” Port says. All the patient has to do is come.

If you’re at high risk, you’ll probably need to start regular screenings under age 40. For example, if a close relative of a woman at high risk has been diagnosed with breast cancer, “a general rule of thumb is to start screening at a high level.” “Women are at risk 10 years before the age of diagnosis, but not before age 25,” says Dr. Berg. “If a woman’s mother is diagnosed at age 45, it makes sense to start screening at age 35.”

When should I advocate for more than just a mammogram?

If You Have Dense Breasts

Almost half of women aged 40 and over dense breast tissueAccording to the National Cancer Institute. Women with dense breasts are not only at higher risk for breast cancer, but these cancers are also more likely to be missed. Dr. In women with the densest breasts, 40 percent of breast cancers are missed on mammography, Berg says.

The only way to find out your breast density is to get a mammogram. And thanks to a new FDA ruleAll mammogram reports now tell patients whether they have dense breast tissue or not.

If you have dense breasts and are not at high risk in any way, need to discuss Dr. Berg says to have an annual MRI or ultrasound with your doctor. (If you don’t have insurance or additional screenings aren’t covered, your out-of-pocket expense can range from approximately $300 to $1,000.) BreastCancer.org reports.) If you have dense breasts and Moreover If you’re at high risk due to a genetic mutation or other factors, you should get an annual MRI in addition to your mammogram, he adds.

For women with dense breasts, there is not yet sufficient evidence for the USPSTF to recommend for or against additional screening with breast ultrasound or MRI; This means that insurance companies have no basis to offer full coverage for these additional tests.

Dr. This leaves “a huge practical gap” for those with dense breasts, Berg says. “’Hey, I’m at higher risk. “I need to get more scans.”

If You Are At High Risk

If you are at high risk for breast cancer, you will need other screenings, such as an MRI or whole breast ultrasound, in addition to regular mammograms. However, Dr. The exact frequency will depend on your personal risk factors, Port says.

Combination of mammogram and MRI finds Dr. Berg says women are the most likely to get cancer, so women should advocate for regular MRIs if they are at high risk.

Meet the experts: Stamatia DestounisMD, chairman of the breast imaging committee of the American College of Radiology. Elisa PortMD, chief of thoracic surgery and director of the Dubin Breast Center at Mount Sinai Hospital in New York City. Wanda K. NicholsonMD, MPH, professor of prevention and community health at George Washington University’s Milken Institute School of Public Health and chair of the U.S. Preventive Services Task Force. Wendy BergMD, PhD, professor of radiology at the University of Pittsburgh School of Medicine and UPMC Magee-Womens Hospital. Dorraya El-AshryPhD, chief scientific officer of the Breast Cancer Research Foundation.

Charlotte Walsh (she/her) is associate news editor of Women’s Health, where she covers the intersection of wellness and entertainment. He was previously a writer at The Messenger, E! News and Netflix. In her spare time, she enjoys reality TV, tennis, and movies starring Nicole Kidman.