Breast cancer screening
Recommendations
USPSTF2024Grade B / I
Biennial screening mammography for women 40-74 (B). Age 75 and older: evidence insufficient (I). Dense breasts with a negative mammogram: evidence insufficient for supplemental ultrasound or MRI (I).
Verify at USPSTF (opens in a new tab)ACS2015
Annual 45-54; option to start 40-44; 55+ may switch to q1-2y; continue while healthy with ≥10y life expectancy.
Verify at ACS (opens in a new tab)ACOG2024
Begin screening at 40 for all average-risk women; q1-2y through ≥75 with shared decision-making.
Verify at ACOG (opens in a new tab)ACP2026
Average-risk women 40-49: discuss risk, values, and the uncertain benefits and harms; if she prefers screening, start biennial mammography. Ages 50-74: biennial mammography. Age 75 and older or limited life expectancy: discuss stopping through shared decision-making. Dense breasts (BI-RADS C or D): consider supplemental digital breast tomosynthesis; do not use supplemental MRI or ultrasound.
Verify at ACP (opens in a new tab)Who this applies to
- USPSTF 2024 (Grade B): all women 40 to 74, every other year. At 75 and older the evidence is insufficient (I). Supplemental ultrasound or MRI for dense breasts in average-risk women: insufficient evidence (I).
- American Cancer Society 2015: yearly from 45 to 54, with the option to start at 40; every 1 to 2 years from 55; continue while life expectancy is 10 years or more.
- ACOG 2024: start at 40, every 1 or 2 years, through at least 75 with shared decision-making.
- American College of Radiology and Society of Breast Imaging: yearly from 40, with a formal risk assessment by age 25 so that high-risk women (BRCA carriers, chest radiation before 30, lifetime risk of 20 percent or more) start earlier and add MRI.
How it is done in practice
- Digital mammography or tomosynthesis (3D); both are acceptable, and tomosynthesis reduces recalls.
- Since September 2024 the FDA requires every mammogram report to tell the patient whether her breasts are dense. Density raises risk modestly and lowers sensitivity, but U.S. guidelines have not agreed on routine supplemental imaging for average-risk women.
- High risk (lifetime risk 20 percent or more by a model such as Tyrer-Cuzick, BRCA1 or BRCA2, or chest radiation between ages 10 and 30): yearly MRI plus mammography, usually from age 30.
- Stop when life expectancy is under 10 years or the patient would not pursue treatment for a finding.
What changed recently
The 2024 USPSTF update moved the start to 40 for all women (it had been an individual decision in the 40s since 2009), citing rising incidence in the forties and higher mortality in Black women. The interval stays biennial. The ACS and ACR still favor yearly screening, at least at first, while ACOG allows every 1 or 2 years. The ACP 2026 update keeps 40 to 49 a shared decision and advises every 2 years from 50 to 74.
Points that matter in clinic
- Family history alone does not define high risk. Run a risk model once, around 25 to 30, and again if the family history changes.
- A lump, nipple discharge or skin change is a diagnostic work-up at any age, not a screening mammogram.
- False positives are common in the forties, roughly 1 in 10 screens leads to a recall. Say so before the first scan so a callback does not become a crisis.