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When should mammography begin?
In recent years, differing guidelines for mammography screening offered by various groups of medical professionals have sparked confusion among patients. With a range of professional opinions, it can be hard to discern which advice is best. When weighing advice on breast cancer screening, it makes sense to look to leaders in breast cancer detection and treatment.
Patients at Average Risk
Iowa Radiology joins the Society for Breast Imaging, the American Society of Breast Surgeons, the American College of Radiology (ACR), the Mayo Clinic, and other leaders in the field of breast cancer detection and treatment in recommending that patients who are at average risk of breast cancer begin annual mammography screening at age 40. Evidence shows this strategy saves lives. The American Cancer Society estimates that 7% of breast cancer deaths in 2022 will occur in women aged 40–49.
Patients at Elevated Risk
One thing that medical organizations agree on is that patients who face a higher risk of breast cancer benefit from beginning screening earlier. To determine breast cancer risk, it’s very helpful to know your family medical history. Other factors, however, also contribute to risk. Examples include lifestyle factors such as exercise and alcohol use, personal medical history, breast density, and radiation exposure. The American College of Radiology recommends,
All women, especially black women and those of Ashkenazi Jewish descent, should be evaluated for breast cancer risk no later than age 30, so that those at higher risk can be identified and can benefit from supplemental screening.
While your doctor can make the best risk assessment, you can get a quick idea of your breast cancer risk by using this risk calculation tool.
Supplemental Screening for Higher-Risk Groups
What type of supplemental screening is recommended for a specific patient depends on the type of risk factors involved.
Earlier Screening
For those whose lifetime risk is calculated to be 20% or more based on genetic factors, the ACR recommends annual digital mammography (either 2-D or 3-D) beginning at age 30. For patients who have received chest radiation therapy, the ACR recommends beginning as early as 25 years of age (depending on when the radiation therapy occurred).
High-Risk Breast MRI
For some patients with a high risk of breast cancer due to factors such as a personal history of breast cancer or atypical hyperplasia, the ACR’s screening recommendations include breast MRI as a supplemental imaging tool. Breast MRI has demonstrated the ability to detect cancers that may be missed in mammography because of their small size or because of the density of the surrounding breast tissue. MRI, however, can miss some signs of cancer that are clearly identifiable with mammography. For this reason, digital mammography remains the standard for breast cancer screening and is used in conjunction with MRI in these cases.
Enhanced Breast Cancer Screening for Average-Risk Groups
As technology advances, radiologists are able to make enhanced breast cancer screening options available to larger groups of patients. Two innovations that are improving breast cancer detection for those at average risk of breast cancer are 3-D mammography and abbreviated MRI. Both technologies have been shown to increase detection of breast cancer, especially in patients with dense breasts. Abbreviated MRI is available to those whose mammograms show dense or very dense breast tissue, while 3-D mammography is an option regardless of breast density. Iowa Radiology uses 3-D imaging technology (also known as tomosynthesis) for all our mammograms.
For the best chance of catching breast cancer early, when it’s most treatable, it’s important to begin annual mammograms at age 40—or possibly earlier if you are at higher risk. Talk to your doctor about your personal risk factors and whether you could benefit from enhanced screening. Iowa Radiology is a patient-focused imaging clinic offering a full range of breast imaging services, including 3-D digital mammography, abbreviated breast MRI, high-risk MRI, breast ultrasound, and imaging-guided biopsy.
Resources
American Cancer Society. Breast Cancer Facts & Figures 2022–2024. Cancer.org. Published 2022. Accessed October 12, 2022. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer-facts-and-figures/2022-2024-breast-cancer-fact-figures-acs.pdf.
American Society of Breast Surgeons. Position Statement on Screening Mammography. BreastSurgeons.org. Published April 9, 2019. Accessed October 12, 2022. https://www.breastsurgeons.org/docs/statements/Position-Statement-on-Screening-Mammography.pdf.
Centers for Disease Control and Prevention. What Are the Risk Factors for Breast Cancer? CDC.gov. Reviewed September 26, 2022. https://www.cdc.gov/cancer/breast/basic_info/risk_factors.htm.
Duffy SW, Vulkan D, Cuckle H, et al. Effect of mammographic screening from age 40 years on breast cancer mortality (UK Age trial): final results of a randomised, controlled trial. Lancet Oncol. 2020;21(9):1165–1172. https://doi.org/10.1016/S1470-2045(20)30398-3.
John Hopkins Medicine. Breast Magnetic Resonance Imaging (MRI). HopkinsMedicine.org. Published June 29, 2011. Accessed October 12, 2022. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/breast-mri.
Monticciolo DL, Newell MS, Moy L, et al. Breast Cancer Screening in Women at Higher-Than-Average Risk:
Recommendations From the ACR. J Am Coll Radiol. 2018;15:408–414. https://www.jacr.org/article/S1546-1440(17)31524-7/pdf
Pruthi S. Mammogram Guidelines: What’s Changed? MayoClinic.org. Published June 25, 2021. Accessed October 12, 2022. https://www.mayoclinic.org/tests-procedures/mammogram/expert-answers/mammogram-guidelines/faq-20057759
Society for Breast Imaging. Why should you begin annual mammography screening at 40? Accessed October 5, 2023. https://assets-002.noviams.com/novi-file-uploads/sbi/end_the_confusion/materials/SBI_mammography_screening.pdf
