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Breast Cancer

MSK Guidelines Won’t Change: Average-Risk Women Should Start Mammograms at Age 40

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“Women’s confusion over when to start breast cancer screening just continues to grow,” says Memorial Sloan Kettering Breast Imaging Chief Elizabeth Morris in response to the release of new guidelines by the American Cancer Society (ACS) on October 20.


MSK Breast Imaging Chief Elizabeth Morris helps a patient through her first digital mammogram. Most mammograms today are done with units such as this one, which generate much more vivid and precise pictures than older film screening technology can.












The ACS recommendations have ignited controversy and left countless women yet again wondering, Am I doing the right thing?

“The bottom line — and what our Breast Service has recommended for years now — is that women at average risk for breast cancer start getting screening mammograms at age 40,” says Dr. Morris. “We know this approach saves lives. MSK’s breast cancer screening guidelines are not changing in any way in light of these new recommendations.”

Why Guidelines Sometimes Differ

There’s actually little disagreement among experts around the world that mammography screening for breast cancer saves lives, notes Dr. Morris. “What differs depends on the greatest relative value that the committee doing the evaluation places on certain things.”

For example, she says, groups such as the ACS have placed the most weight on minimizing challenges for women associated with potential overdiagnosis, false-positive readings, and the need for additional procedures. As a result, the group recommends average-risk women start annual mammograms at age 45 and transition to screening every two years at age 55.

In contrast, MSK places the most emphases on what’s been shown to save the most possible number of lives: annual mammograms beginning at age 40. Groups most focused on minimizing biopsies and repeat scans, on the other hand, recommend that women start annual mammograms at age 50 and continue every other year — as do groups who place the greatest value on keeping costs down.

“Ultimately, the decision about when to start screening is a very personal one,” explains Dr. Morris. “A woman will have to talk to her doctor and decide for herself what she is comfortable with, and proceed from there.”

The new ACS guidelines, authored by a committee headed by MSK primary care physician Kevin Oeffinger and published in the Journal of the American Medical Association, qualify their recommendations to a point by noting that women ages 40 to 45 “should have the opportunity to start screening early if they choose.” These new guidelines address screenings only for women at average risk for breast cancer, not for women at increased risk.

Newer Breast Screening Tools Alter the Picture

Another thing to keep in mind when considering the ACS guidelines, Dr. Morris notes, is that the screening data are based on mammography technology that is “decades-old film screen technology.”

At MSK and most other screening centers across the United States and around the world today, screening mammograms are done with digital technology that generates a much more precise and vivid image than film screen technology is able to capture. As a result, some of the drawbacks that so many experienced at one time, such as misdiagnoses and getting called back for repeat images, are not nearly as common as they once were.

“We’ve progressed so much,” explains Dr. Morris, “and gotten so much more sophisticated and advanced in breast screening technology. It’s a transition I liken to the move from the old computer servers that filled an entire room to the tiny thumb drives we now carry around in our pockets.”


Courtesy of Memorial Sloan Kettering

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