- New guidelines of the American Society of Breast Surgeons recommend that annual screening mammography should begin at age 40 years for the average-risk woman.
Why this matters
- Timing is earlier than that recommended by the most influential professional groups, which are pushing for later start ages, including the US Preventive Services Task Force (age 50 years), the American Cancer Society (age 45 years), and the American College of Physicians (age 50 years).
- For average-risk woman:
- Begin annual screening, 3-dimensional mammography preferred, at age 40 years until life expectancy is
- If a woman has strongly increased breast density (heterogeneously dense or extremely dense), consider supplemental imaging.
- Rationale: 15% mortality reduction for annual screening women aged 40-49 years, according to data used by most other professional groups. Mortality reduction outweighs risks for false-positives, radiation exposure, and overdiagnosis with unnecessary biopsies.
- For women at higher-than-average risk:
- Women with hereditary susceptibility mutation or prior chest wall radiation at ages 10-30 years should have an annual MRI starting at age 25 years, and annual mammography starting at age 30 years.
- Women with predicted lifetime risk >20% by any model or strong family history should have annual mammography starting at age 35 years when recommended by their physician.
- Limited literature search.