Essential Mammogram Guidelines at Every Age

The idea of cancer screenings can seem daunting, but regular mammograms and self-monitoring of your breasts could potentially save your life by finding cancer early. Keep in mind that noncancerous breast issues are more common than cancer. Watching for changes can help you and your physician address concerns quickly and keep your breasts healthy. But knowing when to screen and what to look for can be confusing.

“The U.S. Preventive Services Task Force recommends starting screening at age 50 for women at average risk while the American Cancer Society recommends beginning mammograms at age 45,” says Celette Skinner, Ph.D., Professor and Chair of the Department of Population and Data Sciences at UT Southwestern Medical Center. “Therefore, whether to be screened before age 50 is a personal decision.”

According to the American Cancer Society’s and U.S. Preventive Services Task Force’s guidelines, organized by age, here’s what to schedule and when.

In Your 20s

Become familiar with how your breasts look and feel. This is important so that you can monitor any changes and report them to your physician as soon as possible. Watch for the following:

• Itching or a warming sensation of the skin
  
• Thickening or redness of the skin
  
• Changes in your nipples, like irritation, inversion, or discharge
  
• Swelling of the breast, armpit area, or another part of the chest 
  
• A lump or an unusual change in tissue

Research your family’s medical history in regard to breast cancer and other cancers. Are you at a higher-than-average risk of breast cancer? If so, talk to your health care provider about when to start mammograms.

“The risks women cannot change include getting older (most breast cancers are diagnosed after age 50), genetic mutations (such as BRCA1 and BRCA2), beginning menstrual periods before age 12 and starting menopause after age 55 (prolonging hormone exposure), having dense breasts (diminishes a mammogram’s effectiveness), personal or family history of breast cancer, previous treatment using radiation therapy, and having taken the drug diethylstilbestrol (DES),” Dr. Skinner says. 

In Your 30s

Continue to monitor your breasts for changes and report them to your doctor. Stay up to date on family medical information, such as if a relative is diagnosed with breast cancer (or a type of cancer linked to breast cancer), and let your doctor know. Changes to your breasts or your risk factors might affect when you should start having mammograms.

“Risk factors you can change include not being physically active, being overweight or obese after menopause, taking some types of hormones, and alcohol consumption,” Dr. Skinner says. “Reproductive risk factors that some women can change include having a first pregnancy after age 30, never having a full-term pregnancy, and not breastfeeding. Women should know their family history and, as possible, avoid behaviors that increase their risks. They should also notice and talk to their health care providers about any unusual changes in their breasts.”

In Your 40s

Women ages 40 to 49 should have the choice to start regular breast cancer screenings with mammograms. The pros and cons of screening should be discussed with a doctor before making this decision.Meanwhile, continue to monitor your breasts and be alert to changes in your or your family’s medical history that affect your risk of breast cancer. Report all changes to your doctor immediately.  

“Mammograms – like all cancer screening tests – can lead to both false positive and false negative results,” Dr. Skinner explains. “False negatives fail to find a problem that really exists, whereas false positives can lead to unnecessary medical procedures and psychological distress. You will likely want to begin on the earlier side if you have breast cancer risk factors or if you would rather tolerate the consequences of a false positive than risk missing a problem by not having the test.”

In Your 50s, 60s and Early 70s

Women at average risk of developing breast cancer should begin screening with mammograms every other year at age 50. Talk to your physician about any other necessary tests. Continue to monitor your breasts for changes and report them.

Over 75

Talk to your doctor about whether you need to continue biennial mammograms. For many women it may not be a necessity anymore. And as always, get in touch with your physician at the first sign of changes in your breasts or in your personal or family medical history that affect your risk.