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Breast Cancer Screening: When Should I Start Having Mammograms?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Breast Cancer Screening: When Should I Start Having Mammograms?
Get the facts
Your options
- Start mammograms before age 50.
- Start mammograms at age 50.
If you are at average risk for breast cancer, this information will help you decide when to start having mammograms. If you don't know how high your risk is, talk to your doctor. He or she can help you find out. Sometimes women think that their risk is higher than it really is.
If you are at high risk for breast cancer, you may need to start mammograms at an early age.
Key points to remember
- Mammograms aren't perfect. They may miss some cancers, show something that looks like a tumor when it's not one, or find cancers that will never cause a problem.
- When to start having mammograms is a personal choice. How often you decide to get a mammogram may depend on your age, risk for breast cancer, and overall health.
- Studies show that mammograms can help reduce the number of breast cancer deaths in women ages 40 to 74.1
- In general, women younger than 50 are at a lower risk for breast cancer. The risk for breast cancer goes up as you get older.
- If you're at increased risk for breast cancer, such as having a personal or family history of the disease, you may need to begin mammograms at a younger age and have them more often.
- Experts don't agree on when to start having mammograms. Some suggest a woman should start getting them at age 40, while others advise that she start at age 50. But they do agree that all women should start having mammograms by age 50.
What is a mammogram?
A mammogram is an X-ray of the breast that is used to screen for breast cancer. Screening tests help your doctor look for a certain disease or condition before any symptoms appear. This can increase your chance of finding the problem at a more treatable stage. Often a mammogram can find tumors that are too small for you or your doctor to feel.
Experts have made great progress in treating breast cancer. If it is found early, breast cancer can often be cured, and it is not always necessary to remove the breast.
What are the benefits of mammograms?
A mammogram is one of the most effective screening tools for breast cancer.
Studies show that mammograms can help reduce the number of breast cancer deaths in women ages 40 to 74.1
| Without mammograms | With mammograms | |
|---|---|---|
| Ages 40-49 | 3.5 out of 1,000 women die of breast cancer | 3 out of 1,000 women die of breast cancer |
| Ages 50-59 | 5.3 out of 1,000 women die of breast cancer | 4.6 out of 1,000 women die of breast cancer |
What are the risks of a mammogram?
Like other screening tests, mammograms aren't perfect. They have some limitations. For example, they may miss some cancers. This can delay treatment.
And there are some risks. Each time you have a mammogram, there is a risk that the test:
- May show something that looks like a tumor when it's not one (called a false-positive). This can lead to anxiety and unnecessary tests, such as a breast biopsy.
- Can find cancers that will never cause a problem. For example, some breast cancers may grow so slowly that even without treatment these cancers may never affect a woman's health.2 Since there is no way to know which breast cancers will cause harm, they are usually treated. A study suggests that about 330 out of 1,000 breast cancers found during a screening mammogram may lead to unnecessary cancer treatments, such as surgery, chemotherapy, and radiation.3
The more often you have mammograms, the more often you run the risk that the test will show something that looks like a tumor when it's not one or find cancers that will never cause a problem.
And the chance of having false-positive results is higher when you start having mammograms earlier. A study shows that the number of false-positives is almost twice as high for women who start having mammograms at age 40 as it is for those women who start at age 50.4
Mammograms may not work as well in women before menopause, because breast tissue in younger women is denser than in older women. The more dense the breast tissue, the harder it is to find a tumor.
You are briefly exposed to small amounts of radiation each time you have a mammogram. This exposure can add up over time. But the risk of damage to cells or tissue from being exposed to the level of radiation used for this test is low.
When do experts advise starting mammograms?
For women who are at average risk for breast cancer, there are no easy answers for when to start having mammograms. Even the experts don't agree on when is the best time to start.
For example:
- The American Cancer Society recommends that most women begin screening at age 40, and then have a mammogram every year.
- The U.S. Preventive Services Task Force recommends that most women begin screening at age 50, and then have a mammogram every 2 years.
But experts do agree that all women should start having mammograms by age 50.
In general, women younger than 50 are at a lower risk for breast cancer. The risk for breast cancer goes up as you get older.
| Age | Estimated risk over 10 years |
|---|---|
| 30-39 | 4 out of 1,000 women will get breast cancer |
| 40-49 | 14 out of 1,000 women will get breast cancer |
| 50-59 | 24 out of 1,000 women will get breast cancer |
| 60-69 | 35 out of 1,000 women will get breast cancer |
For women who are at increased risk for breast cancer, experts recommend that these women talk with their doctors about when they should start having mammograms and how often they should have them.
If you have certain risk factors that put you at increased risk for breast cancer, your doctor may suggest that you have a mammogram at a younger age. Women who have a personal or family history of breast cancer or who have inherited a BRCA1 or BRCA2 (say "BRAH-kuh") gene change are much more likely to get breast cancer.
What to Think About
When to start having mammograms is up to you. As you make your decision, here are some things to think about:
- How do you feel about breast cancer screening?
- What is your risk for breast cancer? Sometimes women think that their risk is higher than it really is. If you don't know how high your risk is, talk to your doctor. He or she can help you find out.
- Do you feel that finding a cancer early is worth the risk of having a false-positive test result, which can cause anxiety and lead to unnecessary tests?
- How helpful do you think it would be to find any cancer, whether or not it might ever cause a problem for you?
- Are you worried that you might get breast cancer at an early age?
Talk with your doctor about any questions or concerns you have about when to start screening. He or she can help you decide when to have your first mammogram and how often to have one.
Why might your doctor recommend starting mammograms before age 50?
Your doctor might recommend starting mammograms before age 50 if:
- You have certain risk factors that put you at increased risk for breast cancer, such as a personal or family history of breast cancer or a BRCA1 or BRCA2 (say "BRAH-kuh") gene change.
- You're worried that you might get breast cancer at an early age.
Compare your options
Compare
What is usually involved? |
| |
What are the benefits? |
| |
What are the risks and side effects? |
|
- Before age 50:
- You may get a mammogram every 1 to 2 years, depending on what you and your doctor decide.
- You get regular checkups.
- You go to your doctor if you notice any changes in your breasts.
- For women ages 40 to 74, mammograms can help reduce the risk of dying from breast cancer by finding a cancer early when it can be treated more successfully.
- Earlier screening may help you find breast cancer sooner if the cancer develops before age 50. This may help save your life.
- Mammograms aren't perfect, no matter what age you are when you have them. They may miss some cancers, show something that looks like a tumor when it's not one, or find cancers that will never cause a problem.
- You are briefly exposed to small amounts of radiation each time you have a mammogram.
- Mammograms may not work as well in women before menopause, because breast tissue in younger women is denser than in older women.
- The number of false-positive test results is almost twice as high for women who start having mammograms at age 40 as it is for those women who start at age 50. This may cause anxiety and lead to more radiation exposure and unnecessary biopsies.4
- Until age 50:
- You get regular checkups.
- You go to your doctor if you notice any changes in your breasts.
- At age 50, you start getting mammograms. You may get one every 1 to 2 years, depending on what you and your doctor decide.
- For women ages 40 to 74, mammograms can help reduce the risk of dying from breast cancer by finding a cancer early when it can be treated more successfully.
- Until age 50:
- You avoid the cost and inconvenience of getting a mammogram.
- You limit your exposure to radiation.
- You are less likely to have a false-positive test result in your 50s than you would if you start having mammograms earlier.4
- Mammograms aren't perfect, no matter what age you are when you have them. They may miss some cancers, show something that looks like a tumor when it's not one, or find cancers that will never cause a problem.
- You are briefly exposed to small amounts of radiation each time you have a mammogram.
- There is a small risk that a tumor that develops before age 50 may not be found early. You could miss the chance to start treatment early when it has a higher chance of success.
Personal stories
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
Personal stories about when to start having mammograms
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
My mother and grandmother both died from breast cancer, and my doctor told me that I'm at a higher risk for getting cancer. My doctor helped me to decide that now was a good time for me to start getting regular mammograms. I don't mind having mammograms, because I know that I have a better chance of surviving the disease if a cancer is found early. As a mother of three young children, I want to do everything I can to be here for them.
Tamika, 35
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to start mammograms before age 50
Reasons to start mammograms at age 50
I'm worried that I might get breast cancer at a young age.
I'm not too worried that I might get breast cancer at a young age.
I think starting mammograms earlier is worth the increased risk of having a false-positive test result if it could find cancer early.
I think the chance of having a false-positive test result is more likely than the test finding a real problem if I start having mammograms earlier.
I'm not afraid to have a biopsy or other tests if my doctor sees a problem on the mammogram.
I don't want to have a biopsy or other tests that I may not need.
I want to know if I have a breast cancer, even if it's a cancer that might never cause a problem.
I only want to know if I have a breast cancer that is going to be a problem.
I'm not afraid of being exposed to small doses of radiation each time I have a mammogram.
I don't want to be exposed to any more radiation than is necessary.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Start mammograms BEFORE age 50
Start mammograms AT age 50
What else do you need to make your decision?
Check the facts
Does the risk of breast cancer go up as you get older?
- Yes That's right. In general, women younger than 50 are at a lower risk for breast cancer. The risk for breast cancer goes up as you get older.
- No Sorry, that's not right. In general, women younger than 50 are at a lower risk for breast cancer. The risk for breast cancer goes up as you get older.
- I'm not sure It may help to go back and read "Get the Facts." In general, women younger than 50 are at a lower risk for breast cancer. The risk for breast cancer goes up as you get older.
Can mammograms help save lives?
- Yes That's right. Mammograms can help reduce the number of breast cancer deaths in women ages 40 to 74.
- No Sorry, that's not right. Mammograms can help reduce the number of breast cancer deaths in women ages 40 to 74.
- I'm not sure It may help to go back and read "Get the Facts." Mammograms can help reduce the number of breast cancer deaths in women ages 40 to 74.
Does a normal mammogram guarantee that breast cancer is not present?
- Yes Sorry, that's not right. Mammograms aren't perfect. They may miss some cancers, show something that looks like a tumor when it's not one, or find cancers that will never cause a problem.
- No That's right. Mammograms aren't perfect. They may miss some cancers, show something that looks like a tumor when it's not one, or find cancers that will never cause a problem.
- I'm not sure It may help to go back and read "Get the Facts." Mammograms aren't perfect. They may miss some cancers, show something that looks like a tumor when it's not one, or find cancers that will never cause a problem.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
Certainty
How sure do you feel right now about your decision?
Check what you need to do before you make this decision.
Use the following space to list questions, concerns, and next steps.
Your Summary
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
Your decision
Next steps
Which way you're leaning
How sure you are
Your comments
Your knowledge of the facts
Key concepts that you understood
Key concepts that may need review
Getting ready to act
Patient choices
Credits and References
| Credits | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | Kathleen Romito, MD - Family Medicine |
| Specialist Medical Reviewer | Kirtly Jones, MD - Obstetrics and Gynecology |
- National Cancer Institute (2010). Breast Cancer Screening (PDQ)―Health Professional. Available online at: http://www.cancer.gov/cancertopics/pdq/screening/breast/HealthProfessional.
- Woloshin S, Schwartz L (2010). Benefits and harms of mammography screening: Understanding the trade-offs. JAMA, 303(2): 164–165.
- Jørgensen KJ, Gøtzsche PC. (2009). Overdiagnosis in publicly organised mammography screening programmes: Systematic review of incidence trends. BMJ, 339: b2587.
- Mandelblatt JS, et al. (2009). Effects of mammography screening under different screening schedules: Model estimates of potential benefits and harms. Annals of Internal Medicine, 151(10): 738–747.
- National Cancer Institute (2010). Probability of breast cancer in American women. National Cancer Institute Fact Sheet. Available online: http://www.cancer.gov/cancertopics/factsheet/Detection/probability-breast-cancer.
Breast Cancer Screening: When Should I Start Having Mammograms?
- Get the facts
- Compare your options
- What matters most to you?
- Where are you leaning now?
- What else do you need to make your decision?
1. Get the facts
Your options
- Start mammograms before age 50.
- Start mammograms at age 50.
If you are at average risk for breast cancer, this information will help you decide when to start having mammograms. If you don't know how high your risk is, talk to your doctor. He or she can help you find out. Sometimes women think that their risk is higher than it really is.
If you are at high risk for breast cancer, you may need to start mammograms at an early age.
Key points to remember
- Mammograms aren't perfect. They may miss some cancers, show something that looks like a tumor when it's not one, or find cancers that will never cause a problem.
- When to start having mammograms is a personal choice. How often you decide to get a mammogram may depend on your age, risk for breast cancer, and overall health.
- Studies show that mammograms can help reduce the number of breast cancer deaths in women ages 40 to 74.1
- In general, women younger than 50 are at a lower risk for breast cancer. The risk for breast cancer goes up as you get older.
- If you're at increased risk for breast cancer, such as having a personal or family history of the disease, you may need to begin mammograms at a younger age and have them more often.
- Experts don't agree on when to start having mammograms. Some suggest a woman should start getting them at age 40, while others advise that she start at age 50. But they do agree that all women should start having mammograms by age 50.
What is a mammogram?
A mammogram is an X-ray of the breast that is used to screen for breast cancer. Screening tests help your doctor look for a certain disease or condition before any symptoms appear. This can increase your chance of finding the problem at a more treatable stage. Often a mammogram can find tumors that are too small for you or your doctor to feel.
Experts have made great progress in treating breast cancer. If it is found early, breast cancer can often be cured, and it is not always necessary to remove the breast.
What are the benefits of mammograms?
A mammogram is one of the most effective screening tools for breast cancer.
Studies show that mammograms can help reduce the number of breast cancer deaths in women ages 40 to 74.1
| Without mammograms | With mammograms | |
|---|---|---|
| Ages 40-49 | 3.5 out of 1,000 women die of breast cancer | 3 out of 1,000 women die of breast cancer |
| Ages 50-59 | 5.3 out of 1,000 women die of breast cancer | 4.6 out of 1,000 women die of breast cancer |
What are the risks of a mammogram?
Like other screening tests, mammograms aren't perfect. They have some limitations. For example, they may miss some cancers. This can delay treatment.
And there are some risks. Each time you have a mammogram, there is a risk that the test:
- May show something that looks like a tumor when it's not one (called a false-positive). This can lead to anxiety and unnecessary tests, such as a breast biopsy.
- Can find cancers that will never cause a problem. For example, some breast cancers may grow so slowly that even without treatment these cancers may never affect a woman's health.2 Since there is no way to know which breast cancers will cause harm, they are usually treated. A study suggests that about 330 out of 1,000 breast cancers found during a screening mammogram may lead to unnecessary cancer treatments, such as surgery, chemotherapy, and radiation.3
The more often you have mammograms, the more often you run the risk that the test will show something that looks like a tumor when it's not one or find cancers that will never cause a problem.
And the chance of having false-positive results is higher when you start having mammograms earlier. A study shows that the number of false-positives is almost twice as high for women who start having mammograms at age 40 as it is for those women who start at age 50.4
Mammograms may not work as well in women before menopause, because breast tissue in younger women is denser than in older women. The more dense the breast tissue, the harder it is to find a tumor.
You are briefly exposed to small amounts of radiation each time you have a mammogram. This exposure can add up over time. But the risk of damage to cells or tissue from being exposed to the level of radiation used for this test is low.
When do experts advise starting mammograms?
For women who are at average risk for breast cancer, there are no easy answers for when to start having mammograms. Even the experts don't agree on when is the best time to start.
For example:
- The American Cancer Society recommends that most women begin screening at age 40, and then have a mammogram every year.
- The U.S. Preventive Services Task Force recommends that most women begin screening at age 50, and then have a mammogram every 2 years.
But experts do agree that all women should start having mammograms by age 50.
In general, women younger than 50 are at a lower risk for breast cancer. The risk for breast cancer goes up as you get older.
| Age | Estimated risk over 10 years |
|---|---|
| 30-39 | 4 out of 1,000 women will get breast cancer |
| 40-49 | 14 out of 1,000 women will get breast cancer |
| 50-59 | 24 out of 1,000 women will get breast cancer |
| 60-69 | 35 out of 1,000 women will get breast cancer |
For women who are at increased risk for breast cancer, experts recommend that these women talk with their doctors about when they should start having mammograms and how often they should have them.
If you have certain risk factors that put you at increased risk for breast cancer, your doctor may suggest that you have a mammogram at a younger age. Women who have a personal or family history of breast cancer or who have inherited a BRCA1 or BRCA2 (say "BRAH-kuh") gene change are much more likely to get breast cancer.
What to Think About
When to start having mammograms is up to you. As you make your decision, here are some things to think about:
- How do you feel about breast cancer screening?
- What is your risk for breast cancer? Sometimes women think that their risk is higher than it really is. If you don't know how high your risk is, talk to your doctor. He or she can help you find out.
- Do you feel that finding a cancer early is worth the risk of having a false-positive test result, which can cause anxiety and lead to unnecessary tests?
- How helpful do you think it would be to find any cancer, whether or not it might ever cause a problem for you?
- Are you worried that you might get breast cancer at an early age?
Talk with your doctor about any questions or concerns you have about when to start screening. He or she can help you decide when to have your first mammogram and how often to have one.
Why might your doctor recommend starting mammograms before age 50?
Your doctor might recommend starting mammograms before age 50 if:
- You have certain risk factors that put you at increased risk for breast cancer, such as a personal or family history of breast cancer or a BRCA1 or BRCA2 (say "BRAH-kuh") gene change.
- You're worried that you might get breast cancer at an early age.
2. Compare your options
| Start mammograms BEFORE age 50 | Start mammograms AT age 50 | |
|---|---|---|
| What is usually involved? |
|
|
| What are the benefits? |
|
|
| What are the risks and side effects? |
|
|
Personal stories
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
Personal stories about when to start having mammograms
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"My mother and grandmother both died from breast cancer, and my doctor told me that I'm at a higher risk for getting cancer. My doctor helped me to decide that now was a good time for me to start getting regular mammograms. I don't mind having mammograms, because I know that I have a better chance of surviving the disease if a cancer is found early. As a mother of three young children, I want to do everything I can to be here for them."
— Tamika, 35
"I'm not really worried about getting breast cancer, so I've decided to wait until I'm 50 to start having mammograms. I just turned 40, and I've always been healthy and active. Plus, I don't have any extra risk factors. I've seen the screening guidelines, and I've read that women in their 40s are more likely to have a false-positive test result. I don't need that kind of anxiety in my life! In the meantime, I'm going to check my breasts like I've always done, and continue to get regular checkups with my gynecologist."
— Helen, 40
"My friend was diagnosed with late-stage breast cancer after finding a lump in her breast when she was 48. She didn't have any risk factors for the disease, so she hadn't had any mammograms before then. I can't help but think that maybe if she'd had a mammogram a year or two before, the cancer may have been found earlier. I'm not at high risk for breast cancer either, but I'm going to keep having my yearly mammogram just to be sure nothing is wrong."
— Sally, 46
"I travel a lot for my job, and my days are often crammed with back-to-back meetings, so trying to schedule a mammogram every year is a challenge. But I've managed to get a mammogram every year, and they have all been normal. Now some doctors are saying that it's okay for women to wait and start having mammograms at 50. I think that's reasonable, and I don't feel like I would be putting myself at any greater risk for missing a cancer by waiting until I'm 50 to get my next one."
— Bella, 44
3. What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to start mammograms before age 50
Reasons to start mammograms at age 50
I'm worried that I might get breast cancer at a young age.
I'm not too worried that I might get breast cancer at a young age.
I think starting mammograms earlier is worth the increased risk of having a false-positive test result if it could find cancer early.
I think the chance of having a false-positive test result is more likely than the test finding a real problem if I start having mammograms earlier.
I'm not afraid to have a biopsy or other tests if my doctor sees a problem on the mammogram.
I don't want to have a biopsy or other tests that I may not need.
I want to know if I have a breast cancer, even if it's a cancer that might never cause a problem.
I only want to know if I have a breast cancer that is going to be a problem.
I'm not afraid of being exposed to small doses of radiation each time I have a mammogram.
I don't want to be exposed to any more radiation than is necessary.
My other important reasons:
My other important reasons:
4. Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Start mammograms BEFORE age 50
Start mammograms AT age 50
5. What else do you need to make your decision?
Check the facts
1. Does the risk of breast cancer go up as you get older?
- Yes
- No
- I'm not sure
2. Can mammograms help save lives?
- Yes
- No
- I'm not sure
3. Does a normal mammogram guarantee that breast cancer is not present?
- Yes
- No
- I'm not sure
Decide what's next
1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
Certainty
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
- I'm ready to take action.
- I want to discuss the options with others.
- I want to learn more about my options.
3. Use the following space to list questions, concerns, and next steps.
| By | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | Kathleen Romito, MD - Family Medicine |
| Specialist Medical Reviewer | Kirtly Jones, MD - Obstetrics and Gynecology |
- National Cancer Institute (2010). Breast Cancer Screening (PDQ)―Health Professional. Available online at: http://www.cancer.gov/cancertopics/pdq/screening/breast/HealthProfessional.
- Woloshin S, Schwartz L (2010). Benefits and harms of mammography screening: Understanding the trade-offs. JAMA, 303(2): 164–165.
- Jørgensen KJ, Gøtzsche PC. (2009). Overdiagnosis in publicly organised mammography screening programmes: Systematic review of incidence trends. BMJ, 339: b2587.
- Mandelblatt JS, et al. (2009). Effects of mammography screening under different screening schedules: Model estimates of potential benefits and harms. Annals of Internal Medicine, 151(10): 738–747.
- National Cancer Institute (2010). Probability of breast cancer in American women. National Cancer Institute Fact Sheet. Available online: http://www.cancer.gov/cancertopics/factsheet/Detection/probability-breast-cancer.
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.
Last Revised: November 1, 2012
Author: Healthwise Staff
Medical Review: Kathleen Romito, MD - Family Medicine & Kirtly Jones, MD - Obstetrics and Gynecology
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