The Mammogram Debate: Should Women Start Breast Cancer Screening at 30?

Currently, The American Cancer Society recommends that women be given the option to begin annual mammograms at age 40 – and that all women, regardless of risk factors, start annual mammograms at age 45. There’s a constant back-and-forth between medical professionals about when the appropriate time to start screening is. But this new study suggests that women with risk factors like dense breasts, a personal history of breast cancer or a family history of breast cancer may benefit from annual mammograms before age 40.

Unfortunately, there’s no way to tell if you have dense breasts just by feeling them. When doctors say “dense breasts,” they are referring to the way that breast tissue appears on a mammogram. Dense breasts are really common, and they make cancer harder to detect with traditional mammography.

“The fatty breast tissue has sort of a gray appearance [on a mammogram],” says Dr. Connie Lehman, Chief of the Breast Imaging Division at Massachusetts General Hospital. “But the dense structures, they block the X-ray, so that looks white. Unfortunately, cancers also block the X-ray, and so cancers also look white. When you have a white cancer hiding in white breast tissue, it can be missed. Digital mammography significantly improves the quality of the mammogram.”

Dr. Lehman recommends 3D mammography for women who have dense breasts. The issue is, you’d never know you had dense breasts without getting a mammogram first. This all plays a role in the constant debate about when the proper time for women to start breast cancer screening is.

Lead study author Dr. Cindy Lee, of NYU Langone Health, also noted that younger women have traditionally been ignored when it comes to the mammogram debates. “Women under 40 have not been the focus of our attention when it comes to breast cancer screening,” she said. “Everyone is talking about the 40 to 49 range, and not the 30 to 39 range. It’s difficult to study this group because most women in this age range do not get mammograms, but some of these young women have increased risk for breast cancer and may need earlier and/or supplemental screening.”

Breast cancer in women under 40 is not as common, but is does happen. About 11,000 women under 40 are diagnosed with breast cancer every year, according to Dr. Ann Partridge, an oncologist at Dana-Farber Cancer Institute. And oftentimes, young women are at a later stage when they are diagnosed because regular screening is not recommended.

The other side of the debate says that screening women in their 30s would lead to an increase in false positives and unnecessary biopsies. Doctors do seem to generally agree, however, that 30 is a proper age to discuss your cancer risk with your doctor and decide whether to follow the current mammography guidelines in the U.S.

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