USPSTF Releases New Breast Cancer Screening Guidelines

The United States Preventive Services Task Force (USPSTF) finalized its new breast cancer screening guidelines on April 30. These were largely unchanged from its draft guidelines of 2023, which surprised experts and sparked controversy, with many saying the guidelines didn’t go far enough. 

The new guidelines advise all women to get screened for breast cancer every other year, from ages 40 to 74 — a change from their 2016 recommendation for women to have mammograms every other year beginning at age 50. 

But many experts say people with breasts should have mammograms every year, beginning at age 40 — with higher-risk people starting screening at even younger ages. 

“Breastcancer.org has consistently advocated for mammogram screenings every year, starting at age 40, along with regular self-exams and medical exams,” says Marisa Weiss, MD, founder and chief medical officer of Breastcancer.org. “I’m pleased to see a shift in the right direction [by the USPSTF], but there’s more to be done.”

The task force also looked at the risks and benefits of screening for those 75 and older as well as supplemental screening for women with dense breasts using ultrasound or MRI. But they did not make a recommendation for either. Instead, they concluded that “more research is needed about whether and how additional screening might help women with dense breasts stay healthy and on the benefits and harms of screening in women older than 75.”

Dr. Weiss has concerns about the updated guidelines for women who are 75 and older. “If someone is 75 and in excellent health, she still needs to take reasonable and effective steps to obtain the benefits of early detection,” Weiss said.

The USPSTF  is an independent panel originally set up by the U.S. Department of Health and Human Services in the 1980s to improve preventive care in the country. Most private health insurance plans are required to cover the task force’s priority recommendations, so their guidelines carry a lot of weight.

But the USPSTF isn’t the only organization making breast cancer screening recommendations, and it’s part of the reason why many people are confused about when to start getting mammograms. At least six other independent organizations and panels, including the American Cancer Society (ACS) and the American College of Radiology (ACR), have mammogram guidelines, too.

The task force’s new guidelines are more in line with what the other organizations recommend, but each organization differs slightly in its position. The ACR, for example, does not take a one-size-fits-all approach: In guidelines released in May 2023, it recommends that all women — especially Black women and women of Ashkenazi Jewish descent — get a breast cancer risk assessment at age 25 to determine when they should begin screening.  

With multiple organizations providing contradictory recommendations, it’s no surprise that people are confused about when to start breast cancer screenings and how often they should get them. “Unclear or contradicting mammogram guidelines cause confusion and lead to a missed opportunity for early detection,” Dr. Weiss explains.  

According to the task force, the change is driven by science — namely, that research by the National Cancer Institute has shown that the rate of breast cancer among women ages 40 to 49 increased by 2% per year, on average, from 2015 to 2019. ¹

“More women in their 40s have been getting breast cancer,” Task Force Chair Wanda Nicholson, MD, MPH, MBA, acknowledged in a press release. “By starting to screen all women at age 40, we can save nearly 20% more lives from breast cancer overall. This new approach has even greater potential benefit for Black women, who are much more likely to die of breast cancer.”

The task force noted that Black women are 40% more likely to die from breast cancer than white women and too often get aggressive cancers at young ages. Encouraging Black women to start breast cancer screening at 40 is an important step in the right direction, but it’s far from the only step, the task force noted.  

The recommendation to screen every other year instead of annually is likely related to what some experts see as the harms of screening mammograms.

These experts say that for each breast cancer death screening mammograms prevent, three to four women are overdiagnosed. Overdiagnosis means:

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  a screening mammogram finds a suspicious area that would have been eventually diagnosed as cancer by other means without affecting the prognosis

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  a screening mammogram finds a suspicious area that never would have been diagnosed as cancer if it had been found or treated

False-positive results from screening mammograms also have helped fuel the debate about the value of breast cancer screening and when it should start. When a mammogram shows an abnormal area that looks like cancer but turns out to be normal, it’s called a false positive. Ultimately the news is good: no breast cancer. But the suspicious area usually requires follow-up with more than one doctor, extra tests, and extra procedures — including a possible biopsy. There are psychological, physical, and economic costs that come with a false positive.

The new recommendations are for people with an average risk of breast cancer and are less rigorous than guidelines from other organizations. You may want to opt for more frequent and/or earlier screening if you're in a high-risk group or if you want to ensure the best chance of early detection.

For people assigned female at birth with an average risk of breast cancer, Breastcancer.org recommends yearly screening mammograms starting at age 40, in addition to regular breast self-exams and breast exams by qualified medical experts (such as those performed at annual physicals).

If your breast cancer risk is higher than average, or if you’re not sure what your risk is, talk to your doctor about a breast cancer risk assessment and screening plan that makes sense for you. Your plan may include mammograms starting at an earlier age, or breast MRI or ultrasound screening in addition to annual mammograms.

Learn more about mammogram guidelines.