Featured Expert Pouneh Razavi, M.D. of John Hopkins
Annual mammograms are the best way to detect breast cancer early when treatment is most effective. Yet changing federal guidance about the recommended age to start getting mammograms — from 40 to 50 and now back to 40 again — can be confusing.
Pouneh Razavi, M.D., director of breast imaging in the National Capital Region, oversees breast imaging operations at the Sullivan Breast Center at Sibley Memorial Hospital and Johns Hopkins Medical Imaging in Bethesda. She cuts through the clutter with clear advice for breast cancer screenings.
Q: What are the latest federal guidelines for breast cancer screenings?
A: In May 2023, the U.S. Preventive Services Task Force changed its guidance to recommend that women begin getting annual mammograms at age 40. That reverses its 2009 recommendation, which raised the start age from 40 to 50.
Q: Why did the guidelines for mammogram age change from 50 to 40 in 2023?
A: Data shows that 1 out of 6 new breast cancers develop in people who are in the age range of 40 to 50. Cancers detected during screenings are usually in the early stage, and the earlier we catch cancer, the better the prognosis and survival rate for the patient.
At Johns Hopkins, we have always recommended that our patients start screening at age 40.
Q: Why did the recommended age for mammograms change from 40 to 50 in 2009?
A: Guidelines were changed to age 50 in 2009 partly because of concerns that mammograms starting at age 40 would subject more women to unnecessary false positives, requiring them to go back for additional screenings or even biopsies. Those concerns are real but must be weighed against the benefits of finding cancers earlier.
Q: Can false positives be reduced in mammograms?
A: At Johns Hopkins Medicine, the only clinicians who read breast imaging are radiologists who have been fellowship trained in breast imaging. This helps us keep our false positive rates down across the whole Johns Hopkins system.
Studies show that when you have radiologists dedicated to reading mammograms, as opposed to a wide range of screenings, they tend to flag fewer mammograms for follow-up, and the ones they flag turn out to be true positives.
To keep false positive rates down, we also encourage consultations among the radiologists who read the scans.
Q: Should some people start getting mammograms before the age of 40?
A: Yes. We always tell patients to have this conversation with their gynaecologist or referring physician. For example, patients with a higher-than-average risk, such as those who have a family history of breast cancer or genetic factors such as a mutation of the BRCA gene, are generally urged to start earlier.
Q: Is there an age when people no longer need breast cancer screenings?
A: The new guidelines do not include recommendations for women after age 74, as there is limited data on whether mammograms save lives in that age group. But we have patients who are much older than that and healthy, who would benefit from early detection that would inform treatment decisions. As long as the patient is in good health otherwise, we recommend that they continue getting annual mammograms.
Q: What is the current mammogram guidance for patients with dense breasts?
A: In March 2023, the Food and Drug Administration updated its regulations, requiring that mammography facilities notify patients about the density of their breasts so they can consult with their physicians about whether additional screening is needed.
Dense breasts can make cancers more difficult to detect. All Johns Hopkins sites offer 3D mammography, which gives us much more information because it lets us see the layers of tissue, 1 millimeter at a time.
Q: Should people keep their old mammogram images?
A: Mammography works best when we can compare new images to older ones. We ask our patients to please bring any previous mammogram images to a new mammogram appointment at our facility. Comparing current mammogram images to prior images can be very helpful in assessing for a change. Even if you had a mammogram 15 years ago and you don’t think it’s useful, it is.