Breast cancer is one of the most commonly diagnosed cancers which is one reason why doctors encourage patients to get mammograms, which can identify problems before symptoms appear.
But various medical associations, which put out mammogram guidelines and recommendations, don’t agree on how early or how often people with breasts should start being tested.
The American College of Physicians (ACP) updated their screening guidelines to recommend that people with an average risk for breast cancer.
Those who don’t have a personal or family history of breast cancer, dense breasts, or genes that increase risk should have mammograms every other year starting at age 50. Between 40 and 49, they should discuss the risks and benefits of the screening procedure with a physician.
Like with all screening tests, recommendations around mammograms require a complicated balancing act between the benefits of testing, like finding cancers, and the drawbacks of over testing like the emotional harm of false positives, or providing unnecessary treatments for small tumors that might never have become dangerous.
People under the age of 49 are more likely to need follow-up screening, partly because their breasts are likely to be denser, making scans harder to read, says Linda Moy, a professor of radiology at NYU School of Medicine. They’re also more likely to have false positive scans, which can be anxiety provoking.
Recommending screening starts at age 50 means prioritizing the reduction of those additional tests and over diagnosis, and is looking at the question from the societal, public health level: cutting down the amount spent on testing as much as possible without sacrificing care for the largest number of people.
Many physicians, though, make their recommendations on a patient-by-patient basis, Moy says. “They might say, listen, there’s controversy over mammograms, they do find cancer earlier but they can also have false positives, what would you like to do?”