When Should I Start Getting Mammograms?

Mammography is the most effective method of early detection of breast cancer, helping to diagnose disease at an early stage when treatment is most successful. By using low-energy X-rays, physicians are able to screen for and diagnose abnormalities in the breast tissue.

Screening mammography (looks for changes in the breast versus diagnostic mammography which is taken when an area of concern has been found in the breast) guidelines provided by various national organizations have differing recommendations for when screening should start (ranging from ages 40-50) and how frequently women should have a mammogram (annually or biennially). Patients and healthcare professionals alike often struggle to decide which guideline is the best to follow.

It becomes a bit confusing because the guidelines all come from reputable organizations. But what's important is that all of these organizations recommend some form of regular screening, and that the best plan of care is developed by you and your doctor.

"Recommendations are just that — a point of reference," says Ted James, MD, Chief of Breast Surgical Oncology and Co-Director of the BreastCare Center at BIDMC. "Each patient's individual values, personal preferences and unique risk profiles should be considered as part of a screening plan."

The breast screening controversy mainly arises from the risk of a "false-positive" finding, where a mammogram initially shows a concern for cancer, but then follow-up testing reveals it to be benign or non-cancerous. False-positive findings can result in anxiety and additional tests. As breast imaging improves with more advanced technology, however, the risk of false-positive results is decreasing.

Most guidelines state that women at average risk for breast cancer (no symptoms and no family history) should begin screening between the ages of 40-50. Organizations that recommend screening at 40 place higher value on early diagnosis rather than on the potential of a false positive. All of the guidelines, even those recommending a later start, state that women should have the option to start at age 40 if they so choose.

Guidelines also conflict regarding the frequency of screenings and when a woman should stop getting mammograms. "Since the risk of breast cancer generally increases with age, women may want to consider continuing regular screening for as long as they are in good health," James says.

This is a personal decision. Screening past age 75 is very common and it's available for those who want it.

If you are at high risk of developing breast cancer, your doctor may suggest more frequent mammograms, even beginning earlier than age 40. Common high-risk factors include prior breast cancer, a history of atypical breast lesions, a strong family history of breast or ovarian cancer, or a known genetic predisposition to breast cancer. "It is important for women to know their family history and personal risks," says James.

Regardless of risk factors, James recommends that women should be aware of any changes in their breasts and obtain regular clinical breast exams. "Women who have symptoms such as a lump should also be evaluated with appropriate breast imaging," James says.

Speak with your doctor to determine your individual breast cancer risks and to make a shared decision about screening mammography for you.

The breast imaging facility at BIDMC offers state-of-the-art digital mammography equipment, including 3D mammography or tomosynthesis. The BreastCare Centers in Boston and Needham have trained clinical experts who care for the full range of benign and malignant breast concerns.