When Should You Get a Mammogram?
Screening guidelines vary by organization. Here's a comprehensive comparison to help you and your healthcare provider decide what's right for you.
Guidelines for Average-Risk Women
"Average risk" means you have no personal history of breast cancer, no known genetic mutations (BRCA1/BRCA2), no first-degree relatives with breast cancer, and no history of chest radiation therapy.
| Organization | When to Start | How Often | When to Stop |
|---|---|---|---|
| USPSTF (2024) | Age 40 | Every 2 years (biennial) | Age 74 (insufficient evidence for 75+) |
| American Cancer Society | Age 45 (optional from 40-44) | Yearly ages 45-54; every 2 years at 55+ (or continue yearly) | Continue as long as life expectancy ≥10 years |
| ACR / SBI | Age 40 | Yearly | Continue as long as patient is in good health |
| ACOG | Age 40 (no later than 50) | Every 1-2 years (shared decision) | Age 75+ based on health status and preferences |
| NCCN | Age 40 | Yearly | Continue if life expectancy ≥10 years |
Abbreviations: USPSTF = U.S. Preventive Services Task Force; ACR = American College of Radiology; SBI = Society of Breast Imaging; ACOG = American College of Obstetricians and Gynecologists; NCCN = National Comprehensive Cancer Network.
Why Do Guidelines Differ?
Different organizations weigh benefits and harms differently:
- Early detection: Starting at 40 and screening yearly catches more cancers earlier
- False positives: More frequent screening means more false alarms and biopsies of benign tissue
- Overdiagnosis: Some detected cancers may never cause symptoms or require treatment
- Radiation exposure: Cumulative radiation from repeated mammograms (though individual doses are very low)
The USPSTF weighs avoiding false positives more heavily; radiology organizations prioritize catching every cancer. Neither approach is "wrong"—it's about personal values and risk tolerance.
💡 Shared Decision-Making
Talk to your doctor about your personal risk factors, family history, and preferences. You can start screening earlier or later than guidelines suggest based on your individual situation.
Higher-Risk Women: Special Guidelines
If you have certain risk factors, you may need to start screening earlier and/or add MRI to your screening regimen.
Who Is Considered Higher Risk?
- BRCA1 or BRCA2 gene mutation carriers
- First-degree relative (mother, sister, daughter) with breast cancer
- History of chest radiation therapy (e.g., for Hodgkin lymphoma) between ages 10-30
- Li-Fraumeni syndrome, Cowden syndrome, or other genetic syndromes
- Lifetime breast cancer risk of 20% or higher (based on risk assessment tools)
Screening Recommendations for High-Risk Women
| Risk Factor | When to Start | Imaging Type |
|---|---|---|
| BRCA1/BRCA2 mutation | Age 25-30 | Annual MRI + annual mammogram |
| Prior chest radiation | 8-10 years after radiation (but not before age 25) | Annual MRI + annual mammogram |
| First-degree relative with breast cancer | 10 years before relative's diagnosis age (but not before 30) | Annual mammogram; consider MRI if lifetime risk ≥20% |
| Lifetime risk ≥20% | Age 30 (or earlier based on risk model) | Annual MRI + annual mammogram |
⚠️ Know Your Risk
If you have a family history of breast or ovarian cancer, talk to your doctor about genetic counseling and risk assessment. Tools like the Tyrer-Cuzick model can estimate your lifetime risk and guide screening decisions.
What About Dense Breasts?
About 40-50% of women have dense breasts. Dense breast tissue can hide cancers on mammograms and is associated with slightly higher breast cancer risk.
For women with dense breasts, some organizations recommend considering supplemental screening with:
- Breast ultrasound — Can find cancers not visible on mammogram; may increase false positives
- Breast MRI — Most sensitive but expensive; typically reserved for high-risk women
- Contrast-enhanced mammography — Newer option showing promise
The FDA now requires mammography facilities to report breast density. If you have dense breasts, discuss supplemental screening options with your doctor.
When to Stop Screening
The decision to stop screening is personal and depends on:
- Life expectancy: Screening benefits take ~10 years to materialize; if life expectancy is less than 10 years, risks may outweigh benefits
- Health status: Women with serious health conditions may not benefit from screening
- Personal preferences: Some women prefer to continue screening regardless of age
The USPSTF says evidence is insufficient to recommend for or against screening women 75+. Other organizations say to continue as long as the patient is in good health with reasonable life expectancy.