Mammogram Screening Guidelines Including When and How Often

Mammogram Screening Guidelines According to ACOG, the ACS, and the USPSTF

Doctor Discussing X-Rays with Middle Aged Woman
When should you start getting mammograms and how often should you get them?. Fuse/Getty Images

If you've read any news over the past few years, you're likely confused over when and how often to get a mammogram. Part of the confusion is due to differences in guidelines put forth by organizations such as the American Cancer Society, the U.S. Preventive Services Task Force, and the American College of Obstetricians and Gynecologists.

Screening Mammograms for Breast Cancer

A screening mammogram is an x-ray of the breast used to detect breast changes in women who have no signs or symptoms of breast cancer, like a palpable lump.

While mammograms should be part of every woman's preventive healthcare, many women are unsure of when they need to start breast cancer screening and how often. Let's address this question so you can continue being proactive in your breast health

A Note About Cancer Screening Guidelines

Before explaining the current guidelines for screening mammography, it's important for everyone to understand what guidelines mean. Screening tests are designed to pick up a cancer before a person has any symptoms. If you have any symptoms that could be suggestive of breast cancer, you may need additional testing and should always talk with your doctor. Another important point to note is that guidelines are a method of advising a population of people. Within that population, however, there are some people who are at greater risk of developing the disease than others. Screening guidelines are designed for someone who is at an average risk of developing a disease.

If you have risk factors (just as noted with symptoms above) you may well need additional testing, or earlier institution of screening.

Mammograms as a Screening Tool

Mammograms may be able to pick up a breast cancer before you have any symptoms. Keep in mind, however, that mammograms are not fool proof.

Many of us know of someone who had breast cancer despite a normal mammogram. Depending on your specific risk factors or symptoms, you may require additional testing to evaluate your breasts, such as a breast ultrasound or breast MRI, even if your mammogram is normal.

Guidelines on Breast Cancer Screening

The question of when a women should be screened for breast cancer with a mammogram is not as straightforward as screening for some other types of cancer. For one, different medical professional societies have slightly different guidelines on when to initiate screening and how often to undergo screening. This is based on how they interpret the scientific data on breast cancer—it’s a gray area, meaning they are multiple ways to look at the results of breast cancer studies. 

Secondly, a woman's individual breast cancer risk factors, like her family history, genetic mutations, or any history of abnormal breast biopsies, will affect the timing of when, how often, and what type of breast cancer screening she should undergo. For instance, a woman with a significant family history of breast cancer may need a breast MRI in addition to a mammogram during screening and may need to start screening earlier.

The take home message here is that your doctor is the person who can answer the question of when you should undergo a mammogram. It's a unique decision, so it's not going to be the same for every woman.

That being said, let's take a closer look at what three organizations recommend for initiating and continuing breast cancer screening in the average, healthy woman. 

American Cancer Society Guidelines for Breast Cancer Screening

The American Cancer Society, or ACS,states that women aged 40 to 44 years have the choice to begin yearly breast cancer screenings with a mammogram. In other words, a woman should carefully discuss the risks versus benefits of undergoing a mammogram with her doctor.

For example, an obvious benefit of undergoing screening is that breast cancer may be detected early. A potential risk is a false positive test—a test that shows a suspicious finding for breast cancer that is really non-cancerous. This may require an unnecessary breast biopsy. 

Another concern which has been raised is that of overdiagnosis—that a mammogram will reveal a finding which turns out to be cancer, but in reality, that cancer would never have grown or spread. This would therefore result in overtreatment—exposing a person to unnecessary surgery and perhaps chemotherapy.

According to the ACS, women ages 45 to 54 should undergo a mammogram every year. Women aged 55 and older can undergo a mammogram every year or switch to every two years—again, this would be something to discuss carefully with your doctor. Screening should continue as long as a woman (or man when applicable, since men get breast cancer too) is expected to live at least 10 years or more.

U.S. Preventive Services Task Force Guidelines for Breast Cancer Screening

The U.S Preventive Services Task Force, or USPSTF, recommends that women have a mammogram every two years between the ages of 50 and 74, but that women can discuss starting screening earlier (between 40 and 49) with their physicians, after weighing the harm versus benefit of undergoing a mammogram. The USPTF also adds that a woman with a family history of breast cancer in a parent, sibling, or child may benefit from starting screening between the ages of 40 and 49—since this puts them at higher risk. 

American College of Obstetricians and Gynecologists Guidelines for Breast Cancer Screening

The American College of Obstetricians and Gynecologists, or ACOG, recommends a mammogram beginning at age 40 and yearly after that.

What Does This Mean for You?

Talk with your doctor about the best time to begin breast cancer screening. It's important to know your risk factors for the disease and to be your own advocate with your breast health. Guidelines are again, designed for the "average" person, and your specific circumstances may lead you to want screening more or less often. Also keep in mind that mammograms are not perfect. If you have any breast cancer symptoms or detect a lump, talk to your doctor. If you are still concerned, consider getting a second opinion. You know your body better than anyone else, and if something doesn't seem right it deserves an answer.

Sources:

American Cancer Society. American Cancer Society Guidelines for the Early Detection of Cancer. Updated 07/26/16. http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer

The American Congress of Obstetricians and Gynecologists. ACOG Statement on Breast Cancer Screening Guidelines. 01/11/16. http://www.acog.org/About-ACOG/News-Room/Statements/2016/ACOG-Statement-on-Breast-Cancer-Screening-Guidelines

U.S. Preventive Services Task Force. Final Recommendation Statement. Breast Cancer Screening. 01/01. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/breast-cancer-screening1

DISCLAIMER: The information in this site is for educational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for diagnosis and treatment of any concerning symptoms or medical condition.

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