The Task Force recommends that all women get screened for breast cancer every other year, starting at age 40 and continuing through age 74, to reduce their risk of dying from this disease. This is a B grade.

In this final recommendation statement, we are also urgently calling for more research that will allow us to build on our existing guidance and help all women live longer and healthier lives. Specifically, we need to know how best to address health disparities across screening and treatment experienced by Black, Hispanic, Latina, Asian, Pacific Islander, Native American, and Alaska Native women. We also need studies on what more should be done for women with dense breasts, and we need evidence on the benefits and harms of screening in older women. These are I statements.

Our final recommendation is consistent with the draft. We made several small updates in response to public comments, further clarifying certain parts of the recommendation, such as:

• How the trial and modeling data informed our guidance on screening for people of different ages
• Why we concluded that screening every other year provides a better balance of benefits and harms than screening annually
• The lack of evidence on whether and how additional screening might help women with dense breasts stay healthy

Within the final recommendation statement, there is a section that provides an overview of the themes from the public comments we received and how the Task Force responded to them.

While we have consistently recognized the value of mammography, the latest science makes it clear that we can save even more lives from breast cancer. Previously, we recommended that women in their 40s make an individual decision with their clinician on when they should start screening, taking into account their health history, preferences, and how they value the different potential benefits and harms.

The Task Force now recommends that all women start getting screened for breast cancer every other year starting at age 40. Basically, it’s a shift from recommending women start screening between the ages of 40 and 50 to recommending that all women start getting screened when they turn 40.

This change was driven by two major factors. First, more women in their 40s are getting breast cancer, with rates increasing about 2 percent each year—which means there is more potential benefit to screening. Second, our modeling was able to use new data on screening in the United States and to look at outcomes specific to Black women for the first time.

It is now clear that screening every other year starting at age 40 has the potential to save about 20 percent more lives from breast cancer among all women, and there is an even greater potential benefit for Black women, who are much more likely to die from breast cancer.

The Task Force’s recommendation applies to cisgender women and other people assigned female at birth who are 40 years and older. It includes women at average risk of breast cancer, as well as those with a family history of breast cancer and those with dense breasts. 

The recommendation does not apply to people who have a personal history of breast cancer, who are at very high risk of breast cancer due to certain genetic markers or a history of high-dose radiation therapy to their chest at a young age, or who have had a lesion on previous biopsies. These women should consult their healthcare professional for individualized guidance about screening.

Nearly half of all women have dense breasts, which increases their risk for breast cancer and means that mammograms may not work as well for them. Women are generally told that they have dense breasts after they’ve had a mammogram. These women deserve to know whether and how additional screening might help them stay healthy. Unfortunately, there is not yet enough evidence for the Task Force to recommend for or against additional screening with breast ultrasound or MRI. We are urgently calling for more research on whether and how additional screening might help women with dense breasts find cancers earlier.

It is important to note that all women, including those with dense breasts, should be screened starting at age 40. While we call for more research, these women should talk to their clinicians about their options for follow-up testing so that they can get the care that’s right for them.

Black women are 40 percent more likely to die from breast cancer than White women and too often get aggressive cancers at young ages. Ensuring Black women start screening at 40 is an important first step, yet it is not enough to improve these inequities. It’s important that patients receive equitable and appropriate follow-up after screening and effective treatment of breast cancer. We are urgently calling for more evidence to better understand whether Black women could potentially be helped by different screening strategies.

We reviewed the strongest available science—trial, observational, and modeling data—on mammography to look specifically at the benefits and harms of various screening strategies, including screening every year versus every other year. While annual screening might find some cancers earlier, it is not clear whether this would improve women’s health or change the way their cancer progresses. And, screening every year increases the number of harms, like being told you might have cancer when you don’t, or receiving treatment that was not needed. As a result, the Task Force concluded that screening every other year leads to a better balance of benefits and harms than annual screening.

The Task Force found that there is not enough evidence to make a recommendation for or against screening in women ages 75 and older, so we issued an I statement and are calling for more research on this important topic. In the absence of evidence, these women should decide together with their clinicians what is best for their individual health needs based on their preferences, values, and health history. In the future, we hope that more studies on the effectiveness of screening older women are conducted and published so we can make a more definitive recommendation on how best to care for these women.

No. Right now, most insurance companies are legally required to fully cover mammograms every year starting at age 40 years for women who want them, so many women are able to access free annual mammograms.

It is important to note that our recommendation is based solely on the science of what works to prevent breast cancer, and it is not a recommendation for or against insurance coverage. Coverage decisions involve considerations beyond the evidence about clinical benefit, and in the end, these decisions are the responsibility of payors, regulators, and legislators.

We are urgently calling for more research that will allow us to build on our existing recommendation and help all women live longer and healthier lives. Importantly, we need to know how best to address the health disparities across screening and treatment experienced by so many women. We also need studies on what more should be done for women with dense breasts, and we need evidence on the benefits and harms of screening women 75 and older.