Life begins at 40; mammograms begin at 50

The U.S. Preventive Services Task Force (USPSTF) has confirmed “that women aged 50 to 74 years are most likely to benefit from regular (breast cancer) screening,” in an editorial published in Annals of Internal Medicine to serve as a companion piece to their final recommendations on breast cancer screening. Additionally, “women in their 40s may also benefit from screening; however, their overall likelihood of benefit from screening is lower.” The USPSTF recommendations “support a range of choices for women on when to start screening—from beginning regular mammograms at age 40 or at some point during their 40s or waiting until age 50, when the likelihood of benefit is greater.”

U.S. Preventive Services Task Force final recommendations on breast cancer screening




Women aged 50-74 years

·         Screening mammography every 2 years.

·         Women at an average risk for breast cancer gain the most benefit from biennial screening between the ages of 50 and 74.


Women aged 40-49 years

·         The decision to begin screening mammography before age 50 should be an individual one.

·         “If a woman in her 40s places a higher value on the potential benefit than the potential harms, the scientific evidence indicates that she may want to begin screening, after discussing all of the information with her doctor.”

·         Screening mammography between ages 40-49 may decrease the risk for breast cancer death, but the number of deaths avoided is smaller than that in older women, and the number of false-positive results and unneeded biopsies is larger.

·         The balance between benefits and risks is likely to improve from the early to late 40s.

·         All women undergoing regular screening mammography are also at risk for overdiagnosis – diagnosis and treatment of non-invasive and invasive breast cancer that would otherwise not become a threat to their health during their lifetime.

·         Starting mammography at a younger age and with more frequency may augment the risk of overdiagnosis and overtreatment.

·         Women with a parent, sibling, or child with breast cancer at an increased risk and may benefit from starting screening in their 40s.


Women aged 75-older

·         The current evidence is not enough to determine the balance of benefits and harms.


All women

·         The current evidence is not enough to determine the balance of benefits and harms of digital breast tomosynthesis (DBT) as a primary method for screening for breast cancer.


Women with dense breasts

·         The current evidence is not enough to determine the balance of benefits and harms of adjunctive screening for breast cancer using breast ultrasonography, magnetic resonance imaging, DBT, or other methods in women identified to have dense breasts on an otherwise negative screening mammogram.


These recommendations are applicable to asymptomatic women aged 40 or older who do not have pre-existing breast cancer or a previously diagnosed high-risk breast lesion and who are not at high risk of breast cancer due to an unknown underlying genetic mutation or a history of chest radiation at a young age.


*Grade definitions



Suggestions for practice


The USPSTF recommends the service. There is high certainty of a substantial net benefit.

Offer or provide this service.


The USPSTF recommends the service. There is high certainty of a moderate net benefit; or, moderate certainty of a moderate-to-substantial net benefit.

Offer or provide this service.


The USPSTF recommends selective offering of this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty of a small net benefit.

Offer or provide this service for selected patients depending on individual circumstances.


The current evidence is not enough, of poor quality, or conflicting to determine the balance of benefits and harms.

Read the clinical considerations section of USPSTF Recommendation Statement. If the service is offered, patients should understand the uncertainty about the balance of benefits and harms.


**It is important to note that a C grade is not a negative but a positive recommendation that in this case recognizes a small net benefit in starting screening at 40 years of age.

The USPSTF acknowledges that “in 2015, contentious discussions about breast cancer screening and prevention continued, with physicians, advocates, lawmakers, and scientists all lending their voices to the debate… Much attention has been focused on the differences among the guidelines and recommendations issued by various cancer prevention advocates and professional societies,” the editorial says, going on to focus on the similarities instead. “The USPSTF, the American Cancer Society, and many others have affirmed that mammography is an important tool to reduce breast cancer mortality, and that the benefits of mammography increase with age. Most guidelines suggest that there is value in mammography screening for women in their 40s. Support of a personal, informed choice for women in their early 40s is also widely shared, not just by the USPSTF and the American Cancer Society, but also by the American College of Physicians, the American Academy of Family Physicians, and the Canadian Task Force on Preventive Health Care.”

Furthermore, the Task Force’s 2016 recommendations differ from the 2009 version in that the USPSTF looked for the first time at the effectiveness of 3D mammography as a screening tool, concluding that there is little evidence of its efficacy to make a recommendation either for or against it. The Task Force also took a first-ever look at the effectiveness of additional screening for women known to have dense breasts but an otherwise negative mammogram. It is unclear whether or not ultrasound, MRI, or 3D mammography may help women with dense breast. Therefore, the USPSTF is unable to recommend or discourage additional screening. “We are hopeful that our recommendations on breast cancer screening will be perceived as an important part of a growing consensus among experts in evidence-based medicine,” the editorial concludes. “All women deserve to understand the many parallels among the various expert recommendations and guidelines—and the differences—so they are empowered to make the best choice for themselves, together with their doctor. We hope our work can help advance progress in that direction for the benefit of all women.”

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