Helping You Better Understand Your Risk
- Most medical groups still recommend starting mammograms at 40, despite the ACP reaffirming age 50; Dr. Rosenbaum Smith emphasizes that “mammograms are our gold standard” and says surgeons and radiologists continue to support beginning at 40.
- Dense breasts require extra imaging: Because dense tissue can hide tumors on mammograms, specialists typically add annual breast ultrasound and do not recommend stopping screening based on age.
- Family history and genetics shift screening earlier: women with a first‑degree relative begin imaging 10 years before that relative’s diagnosis, while those with BRCA or similar mutations start MRI‑based screening at 25.
- Risk calculators help identify women who need intensified screening: tools like the IBIS/Tyrer‑Cuzick model flag women with a 20%+ lifetime risk, prompting earlier MRI (often starting at 30); Dr. Rosenbaum Smith explains that “it gives you a risk score” that guides individualized screening plans.
The U.S. Preventive Services Task Force lowered its own starting age to 40 in 2024, and the American College of Radiology pushed back strongly on the ACP’s guidance.
Read MoreDense Breasts? Expect an Ultrasound, Too
Nearly half of women have dense breasts, meaning they have more glandular and fibrous tissue than fatty tissue. Dense tissue appears white on a mammogram — the same color as a tumor — which can make cancers harder to spot. That’s why many breast specialists add a second test.
“If you have dense breasts, we add on an ultrasound to that,” Dr. Rosenbaum Smith explains. “And usually it’s done at the same time because it really helps to look at that dense breast tissue and to add an extra layer of evaluation.”
She recommends this screening every year, and she doesn’t set an age at which women should simply stop.
“We recommend doing that annually,” she says. “There really is no time period where we tell someone to stop doing it.”
RELATED: Reducing Anxiety About False Positives
Family History Moves Your Start Date Earlier
A close relative’s diagnosis changes the timeline.
Dr. Rosenbaum Smith uses a simple rule: begin screening 10 years before the age at which your first-degree relative — a mother, sister, or daughter — was diagnosed.
“If you have a family history, we start imaging 10 years before a first-degree relative with breast cancer,” she says. “So, if your mother had breast cancer at 45, you are going to begin your imaging at the age of 35.”
Carrying a Breast Cancer Gene? Start at 25
Women who inherit a mutation in a breast cancer gene, such as BRCA1 or BRCA2, face a much higher lifetime risk and often develop cancer at younger ages. For them, screening starts far earlier.
“If you have a genetic predisposition to cancer, meaning you test positive for one of the breast cancer genes, then we recommend screening starting at the age of 25,” Dr. Rosenbaum Smith says.
For women in this group, early screening typically relies on breast MRI, with mammograms added in later years. Your doctor or a genetic counselor can map out the exact schedule for your specific mutation.
A Simple Online Tool Can Flag Higher Risk
Not every woman at elevated risk has a known gene mutation or a mother with breast cancer. To catch those cases, doctors use risk models that weigh several factors at once.
“Now, to add one more layer to it, there are certain risk models out there which we can use to calculate a person’s risk to say if they’re high risk or not,” Dr. Rosenbaum Smith explains. “The one that I typically use is something called the IBIS scale, otherwise known as the Tyrer-Cuzick Risk Calculator for Breast Cancer Risk Assessment.”
RELATED: Your Breast Density Is Not Static; The Way It Changes Over Time May Reveal Your Breast Cancer Risk
The calculator asks for a handful of details:
- Age
- Breast density
- Any previous breast biopsies
- Height and weight
- Use of hormone replacement therapy
- Family history of breast cancer
“It’s a very simple online program where you put in a couple of risk factors,” she says.
“When you put it into that, it gives you a risk score. If your risk is over 20, you are considered at a higher risk of breast cancer.”
That threshold refers to an estimated lifetime risk of 20% or more. Women who cross it qualify for more intensive screening, usually including annual breast MRI.
“And in those individuals, we are starting screening earlier than the age of 40,” Dr. Rosenbaum Smith says.
“So we generally will start MRIs at the age of 30 if you have an elevated [risk] BI-RADS score. So we have tools available to us to help individualize the treatment care for patients.”
The American College of Radiology recommends that every woman have a breast cancer risk assessment by age 25, so that those who need earlier or additional screening are identified in time.
RELATED: Mammograms Are Still the Best Tool for Detecting Breast Cancer — A Warning About Thermography
Questions to Ask Your Doctor
- When should I get my first mammogram, and how often should I have one?
- Do I have dense breasts? If so, should I add an ultrasound or MRI?
- Based on my family history, should I start screening before 40?
- Should I consider genetic testing for breast cancer genes?
- Can you calculate my lifetime risk using a tool like the Tyrer-Cuzick (IBIS) model?
- If my risk is above 20%, what does my screening plan look like?
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