New NCCN Breast Cancer Screening Guidelines: Annual Mammograms Should Start at 40
Aiming to clarify when women should start having mammograms, the National Comprehensive Cancer Network (NCCN) has released new guidelines for breast cancer screening and diagnosis that say all women age 40 and older at average risk of breast cancer should have annual mammograms.
The guidelines were published online in July 2022 and are available as a downloadable PDF. Read Breast Cancer Screening and Diagnosis.
Recommendations differ on when to start screening mammograms
From 2000 to 2015, a number of large studies ignited debate over when people should begin having screening mammograms.
Public health experts agree that breast imaging saves lives but question the value of screening mammograms. These experts say that for each breast cancer death screening mammograms prevent, three to four women are overdiagnosed.
a screening mammogram finds a suspicious area that would have been eventually diagnosed as cancer by other means without affecting the prognosis
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.
Because of the continued debate, a number of organizations revised their breast cancer screening recommendations for women at average risk of breast cancer. Some organizations recommend starting screening mammograms at age 50, and others recommend starting at age 40. At the same time, some organizations recommend having a mammogram each year, and others recommend having a mammogram every other year. As a result, there is confusion about when you should start having screening mammograms, as well as how often you should have them.
At Breastcancer.org, we believe:
all women should have a screening mammogram every year starting at age 40 and continue to do so as long as they are in good health and would want the breast cancer to be treated
all women should have a physical exam of the breasts by a doctor every year and do a breast self-exam every month
all people who identify as transgender or gender non-conforming should talk to a doctor about a breast cancer screening schedule that makes sense for them
The NCCN said it released the new guidelines to simplify the message.
“There are many, often conflicting, recommendations surrounding breast cancer screening, which causes a lot of confusion and apprehension,” Therese Bevers, MD, professor of clinical cancer prevention at the University of Texas MD Anderson Cancer Center, and chair of the panel that wrote the new guidelines, said in a statement. “These are the latest, evidence-based guidelines from experts in the field of breast cancer screening and diagnosis from more than two dozen leading cancer centers in the United States.”
What the guidelines say
Regarding screening, the guidelines say:
Every person has some risk of developing breast cancer.
Some people have a higher-than-average risk of developing breast cancer because of family history, a genetic mutation, a benign breast disease diagnosis, or radiation therapy to the chest at a young age.
Everyone assigned female at birth should have a breast cancer risk assessment by age 25, which helps determine when it’s best to start having screening mammograms.
Women age 40 and older at average risk of breast cancer should have a physical exam and a mammogram every year.
Women with a higher-than-average risk of breast cancer should have a physical exam every six to 12 months. Screening should start before age 40 and include an annual mammogram or breast MRI. The guidelines also say that if a family member has been diagnosed with breast cancer, you should start breast cancer screening when you’re seven to 10 years younger than your family member was when she or he was diagnosed. For example, if a family member was diagnosed at age 45, you should start screening between the ages of 35 and 38.
The guidelines also address how doctors should evaluate the most common breast symptoms, such as a palpable lump, pain, or nipple discharge. Still, it’s important to discuss any unusual breast symptoms with a doctor. There are also breast cancer screening recommendations for women who are pregnant or breastfeeding.
“Everyone with breasts carries some risk of breast cancer, so the key is to know your risk,” Dr. Bevers added. “Most women with average risk should get screened every year, beginning at age 40, but if there are additional risk factors present, a provider might recommend an earlier start.”
What this means for you
At Breastcancer.org, we believe your best chance for early detection requires coordination of the current screening tools:
clinical breast exam
If you’re not using all three tools starting at age 40, it’s a missed opportunity for early detection.
The reality is that everyone with breasts is at risk for breast cancer, and this risk tends to increase over time. It’s important to understand your health information related to breast cancer risk and to keep your doctor updated throughout your life. Here are some points to bring up to your doctor:
family history of breast or other related cancers (ovarian, melanoma)
any test results for gene mutations linked to a high risk of breast cancer
results of past breast biopsies, even if they were benign
personal history of radiation treatment to the face, chest, or both before age 30
level of physical activity
any use of post-menopausal combined hormone replacement therapy (HRT)
alcohol consumption, if you regularly drink more than three alcoholic beverages a week
the amount of processed food and trans fats you eat
your smoking history
whether or not you have carried a pregnancy to term or have breastfed
If you have a higher-than-average risk of developing breast cancer, you should talk to your doctor about starting annual mammograms at a younger age and consider other screening tools (such as MRI or ultrasound) to increase your chances of early detection.
Learn more about Screening and Testing.
Written by: Jamie DePolo, senior editor
— Last updated on September 12, 2022, 11:07 PM