The recommended age to start getting mammograms is 40. The U.S. Preventive Services Task Force (USPSTF) recommends screening every two years from age 40 through 74 for women at average risk of breast cancer. This represents a recent shift: the starting age was previously 50 for routine screening, with screening in your 40s treated as optional.
Why the Starting Age Dropped to 40
For years, major medical organizations disagreed about whether average-risk women should begin mammograms at 40 or 50. The USPSTF previously recommended starting at 50, while some groups like the American Cancer Society suggested women could choose to start at 40 or 45. That split created real confusion.
The guidelines have now converged. The USPSTF updated its recommendation to start screening at 40, and the American College of Obstetricians and Gynecologists (ACOG) followed with the same change. ACOG noted that “the benefits of diagnosing breast cancer earlier outweigh those risks enough to warrant starting to get mammograms at age 40.” The National Comprehensive Cancer Network, the American College of Radiology, and the Society of Breast Imaging all align with this starting age. If you’re 40 or older and haven’t had a mammogram yet, the current consensus is clear: it’s time to schedule one.
How Often You Need Screening
The USPSTF recommends a mammogram every two years from age 40 to 74. ACOG takes a slightly more flexible position, recommending screening every one or two years based on a conversation between you and your doctor. The key difference is whether you screen annually or every other year, and that decision often depends on your personal risk factors, breast density, and preferences.
After age 74, the evidence becomes less clear. The USPSTF doesn’t make a recommendation for or against screening beyond 74 because there isn’t enough data to say definitively whether the benefits continue to outweigh the downsides at that age. In practice, many women over 74 continue screening if they’re in good health, but it becomes more of an individual decision.
If You’re at Higher Risk, Start Earlier
The age-40 recommendation applies to women at average risk. If you carry a BRCA1 or BRCA2 gene mutation, or have a strong family history of breast cancer, the timeline is different and more aggressive. Guidelines for high-risk women recommend starting annual MRI screening at age 25 and adding mammography at age 30. The American Cancer Society recommends both MRI and mammography annually starting at 30 for high-risk patients.
You’re generally considered higher risk if you have a known genetic mutation, a first-degree relative (mother, sister, daughter) diagnosed with breast cancer, or a history of chest radiation therapy before age 30. If any of these apply to you, talk to your doctor about starting screening well before 40.
What About Dense Breasts?
Breast density matters because dense tissue can hide tumors on a standard mammogram, making cancers harder to spot. About half of women in their 40s have dense breasts. If your mammogram report says you have dense breast tissue, you may wonder whether you need additional imaging like ultrasound or MRI.
Supplemental screening with ultrasound or MRI does detect additional cancers that mammography misses in women with dense breasts, and most of those additional cancers found are invasive. However, these extra tests also lead to significantly more callbacks and biopsies that turn out to be benign. No major clinical guideline currently mandates supplemental screening based on breast density alone, though many states now require that you be notified if you have dense breasts. It’s worth discussing with your doctor whether additional imaging makes sense given your overall risk profile.
The Tradeoffs of Starting at 40
Starting mammograms at 40 catches more cancers earlier, but it also means more false alarms. Over a decade of screening, a significant number of women will get called back for additional imaging or a biopsy that ultimately shows no cancer. A pooled analysis across studies found an overdiagnosis rate of about 12.6% among women 40 and older. Overdiagnosis means detecting a cancer through screening that would never have caused symptoms or harm during a woman’s lifetime, potentially leading to unnecessary treatment.
These tradeoffs are real but, according to the current consensus, don’t outweigh the benefit of catching aggressive cancers early, when treatment is more effective and less invasive. The shift to recommending screening at 40 reflects a judgment that the lives saved justify the anxiety and extra procedures that come with earlier and more frequent screening.
Insurance Coverage for Mammograms
Under the Affordable Care Act, most insurance plans must cover screening mammograms with no out-of-pocket cost for women 40 and older. This applies every one to two years. If your plan is ACA-compliant, you shouldn’t face a copay, deductible, or coinsurance for a routine screening mammogram. Diagnostic mammograms, ordered because of a symptom or abnormal finding, may be billed differently and could involve cost sharing depending on your plan.
Screening for Transgender Individuals
The USPSTF’s age-40 recommendation applies to anyone assigned female at birth, including transgender men and nonbinary individuals, regardless of current gender identity. If you were assigned female at birth and still have breast tissue, standard screening guidelines apply.
For transgender women (assigned male at birth) who use feminizing hormones, the timeline is different. Screening mammography is generally recommended starting at age 50, but only after at least 5 to 10 years of hormone use. This reflects the fact that breast cancer risk in transgender women is lower than in cisgender women but increases with prolonged hormone exposure. Once both criteria are met, screening every two years is recommended. If you have significant family risk factors, your doctor may recommend starting sooner.