The everyWoman Blog: At What Age Should You Start Getting Mammograms? It’s Complicated

younger woman getting mammogram

At what age should you get your first mammogram? Er … umm … well … The reason I’m stumbling here is that the when-to-get-a-mammogram debate has been a hot one over the past several years, with one camp repeating the old advice that women should start at age 40, and another challenging that idea, claiming most women should wait until age 50. Which advice you follow depends somewhat on your breast cancer risk factors. Ultimately, it’s up to you and your doctor.

A mammogram is simply an X-ray picture of the breast. Screening mammograms are used to check for breast cancer in women with no signs of the disease; diagnostic mammograms are used to check for cancer after a lump or other disease symptom has been discovered. There’s a specious logic to the idea that if mammograms help detect breast cancer, and early breast cancer detection helps saves lives, starting to get mammograms at an early age would be best—after all, clinical trials have shown that screening mammography can help reduce the number of deaths from breast cancer in women ages 40-74.

But there are dangers associated with mammography, too—radiation exposure, false-negative results, false-positive results. After 10 mammograms, more than half of 40-something women will have a false positive, in which the mammogram detects something suspicious that turns out to be benign, says Laura Petitti, a doctor at Arizona State University and vice chair of a 2009 U.S. panel on mammogram recommendations.

By far the most debated danger, however, is the diagnosis and treatment of cancers that would not have ever wound up causing symptoms or threatening a woman’s life. Studies suggest that 1% to 10% of breast cancers found through mammograms fall into this category. Unfortunately, doctors can’t currently distinguish between cancers or ductal carcinoma in situ (a noninvasive lesion in which abnormal cells that may become cancerous form in the lining of breasts) that will remain harmless and cancers that do need to be treated, so they’re generally all treated. But overdiagnosis and overtreament of breast cancer exposes women to the negative health effects of cancer therapy, in addition to the emotional and financial costs of cancer, for essentially no good reason.

In 2009, the U.S. Preventive Services Task Force changed its previous recommendation that women start getting mammograms at age 40; it now recommends mammograms for women every other year starting at age 50. Advocacy groups such as the National Breast Cancer Coalition, Breast Cancer Action, and the National Women’s Health Network welcomed the new guidelines.

A study accompanying the recommendations, published in the Annals of Internal Medicine, said doctors would have to screen 1,904 women ages 39-49 for a decade to prevent one breast cancer death, vs. 1,339 women 50-59 and 377 women 60-69. In other words, while earlier mammograms do occasionally help save individual younger women’s lives, their overall effect is miniscule. Of course, if you’re the one woman out of 1,904 whose life would be saved by starting to get mammograms at age 40—or your mom, or sister, or best friend is that woman—the overall statistics don’t really matter. That’s why recommendations like these are so tricky.

The National Cancer Institute still recommends that women have a screening mammogram every 1 to 2 years beginning at age 40. Women with certain breast cancer risk factors—a family history of breast cancer, genetic alterations, periods that started before age 12, radiation therapy to the chest before age 30—should talk to their physicians about the possibility of starting mammography earlier. The American Cancer Society says women age 40 and older should have a screening mammogram every year.

Did you, or do you plan to, start getting mammograms at age 40?

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