What Are Today's Mammogram Guidelines?

In late 2009, the United States Preventive Task Force (USPTF) issued new recommendations for mammogram screening. The prevailing guidelines were for women to start screening mammograms at age 40 and then have annual mammograms. The USPTF instead recommended women with no known risk factors start screening at age 50 and have follow-up mammograms every two years. The task force members determined that the benefits of annual mammograms for women in their 40s did not outweigh the risks.

These recommendations triggered a firestorm of angry responses from physicians, organizations such as the American Cancer Society, and individual women. The debate still rages. A recent study found that eight out of 10 women believe guidelines discouraging routine mammograms for women under 50 are "unsafe." However, experts at the University of Massachusetts Medical School say women grossly overestimate their lifetime risk of developing breast cancer.

Michael LeFevre, MD, a member of the USPTF, says he discusses mammograms with women at 40, recommends and encourages them at 50, and strongly encourages them at 60. Furthermore, he says screening every other year instead of annually gives women most of the benefits of yearly mammograms, but significantly cuts the risk of harms.

Until now, screening guidelines have been a one-size-fits-all approach based primarily on age. However, newer guidelines take a more personalized approach and may go a long way towards easing anxiety about when and how often to screen.

A July 2011 study in the Annals of Internal Medicine reported that breast density is the strongest risk factor for breast cancer. The study authors recommend an initial mammogram screening at age 40 to assess a woman's breast density. Then the woman and her physician should develop a schedule for future mammograms based on her individual risk factors and her personal beliefs about the potential benefits and harms of screening.

Breast density, which is mostly inherited, describes the amount of white area on the breast that otherwise appears black on mammograms. The balance of black and white reflects the breast composition and relative amounts of fat, glandular tissue, and connective tissue. Dense breasts have less fatty tissue and more non-fatty tissue. Breast density generally decreases during menopause. However, for some women it persists, putting them at higher risk for breast cancer.

If you're already getting screening mammograms, ask your physician about your breast density and if it might affect your breast cancer risk.



"New Guidelines: Start Mammograms at 40, not 50." KTLA.com. Web. 20 July 2011.

American College of Obstetricians and Gynecologists. "Annual Mammograms Now Recommended for Women Beginning at Age 40." Web. 20 July 2011. http://www.acog.org/from_home/publications/press_releases/nr07-20-11-2.cfm

Joelving, Frederik. "New breast cancer guidelines "unsafe": women." Reuters. Web. 27 May 2011.

BreastCancer.org. "Personalizing Mammography by Breast Density and Other Risk Factors." Web. 5 July 2011. http://www.knowbreastcancer.org/news-research/news/personalizing-mammography-by.html

National Cancer Institute. "Breast Density in Mammography and Cancer Risk." Web. 2008.

Charles Bankhead. "Dense Breasts Hike Risk of Aggressive Cancer." BreastCancer.org. Web. 1 August 2011. http://www.breastcancer.org/risk/new_research/20110801.jsp