The great mammogram debate: Starting screenings earlier will save lives

When should women start getting mammograms? It’s a simple question, and it should have a straightforward answer. Yet, conflicting screening guidelines over the past several years have left women in limbo — potentially without life-saving care. Fortunately, that may now change thanks to new guidance from the U.S. Preventive Services Task Force (UPSTF).

Until recently, the UPSTF advised women of average risk for breast cancer to begin receiving biennial mammograms at 50. In early May, the UPSTF reversed course and issued a draft recommendation that women start screening at age 40 and continue receiving mammograms every other year until age 75. While leading medical associations like the American Cancer Society (ACS) still advise that average-risk women 40 years and older get mammograms annually instead of biennially, UPSTF’s shift to start screenings earlier is a step in the right direction.

First, this move will help reduce the breast cancer mortality rate. According to the American College of Radiology, “One in six breast cancers occurs in women in their 40s.” Studies show that 75% of women diagnosed with breast cancer have no family history and aren’t considered high-risk. Mammograms aid in early detection and treatment and enhance overall patient outcomes. Since 1990, these screenings have decreased the breast cancer mortality rate in the U.S. by nearly 40%. The UPSTF predicted its change alone could “result in 19 percent more lives being saved.”

Second, the UPSTF’s action will help address existing health disparities associated with breast cancer. An ACS report shows that Black women have a 4% lower incidence rate of breast cancer but are 40% more likely to die from the disease than white women. Black women are also more likely to be diagnosed with triple-negative breast cancer, which is more aggressive and harder to treat. Further, they are more likely to carry a dangerous genetic mutation. Studies continue to indicate that screenings could help Black women find their breast cancer when treatments are more likely to be effective.

UPSTF’s decision to recommend a starting age of 40 for breast cancer screenings is a welcome one. But as the independent panel indicated, additional research into health disparities is needed.

As we delve deeper into the potential causes and solutions of these inequities, we must stay united in what we do know—average-risk women should begin receiving mammograms at age 40. Yearly screenings will save the most lives by facilitating early detection and improving treatment outcomes.

Editor’s note: Stacy Smith-Foley, M.D., is a board-certified breast imaging specialist and founding physician of The Breast Center at CARTI. For more information, visit CARTI.com. The opinions expressed are those of the author.