Breast Cancer Screening: When Should Women Get a Mammogram?

“When should I start getting a mammogram?”

 This is one of the most common questions women ask, and the answer is not necessarily the same for every woman.

Mammography is an important screening tool for detecting breast cancer before it causes symptoms, when cancers may be smaller and more amenable to treatment. However, the appropriate age and frequency of screening depend on a woman’s age, personal risk, family history, genetic factors and breast health.

So, when should you start?

For women at average risk, the Breast Imaging Society of India recommends starting mammography-based screening at 40 years of age, with annual mammography generally advised until 70.

 A practical approach is:

• Age 20 onwards: Become familiar with how your breasts normally look and feel. Women may practice breast self-examination (BSE) and should report any new or persistent change promptly. The Indian National Institute of Cancer Prevention and Research suggests BSE as an option from age 20.
• Age 30 onwards: Regular clinical breast examination (CBE) by a trained healthcare professional is recommended in Indian early-detection programmes.
• Age 40 onwards: For women at average risk, annual screening mammography is appropriate in the Indian setting.
• After 70: Screening should be individualized, taking into account overall health, other medical conditions and life expectancy.

What if I am younger than 40?

Routine mammography is not generally recommended for average-risk women below 40. However, this does not mean that a woman under 40 should ignore a breast symptom.

A new lump, nipple discharge, nipple retraction, skin or nipple change, persistent focal pain, or any other unusual breast change should be evaluated promptly—irrespective of age.

This is diagnostic evaluation, not routine screening.

In younger women, particularly those with dense breasts or a suspicious clinical finding, ultrasound is often an important complementary investigation. MRI or contrast-enhanced mammography (CEM) may be considered in selected situations, depending on the clinical and imaging findings and the woman's individual risk. MRI is not a routine screening test for average-risk women.

What if I have a family history or genetic risk?

Women at higher-than-average risk need a different screening strategy.

This includes women with a strong family history of breast/ovarian cancer, a known BRCA1/BRCA2 or other pathogenic genetic variant, previous chest radiation at a young age, or a calculated lifetime breast-cancer risk of around 20% or more.

Such women may need earlier and more intensive screening, often with annual mammography combined with breast MRI. The exact age at which screening begins depends on the underlying risk.

One important point about BRCA and ovarian cancer

Women with a BRCA mutation have an increased risk of both breast and ovarian/fallopian-tube cancer and should receive genetic counselling and individualized risk-reduction advice.

However, routine ultrasound and CA-125 are not proven to be effective screening tests for ovarian cancer, even in high-risk women. They may sometimes be used as part of individualized surveillance when definitive risk-reducing surgery is being considered or deferred, but this should be discussed with a specialist.

And remember, screening is not the same as diagnosis

A mammogram is a screening test when a woman has no breast symptoms.

If you have a lump or another new breast change, do not wait for your next scheduled mammogram. You should have a clinical assessment and appropriate diagnostic imaging promptly.

Know your breasts. Know your risk. Detect breast cancer early.

Early detection can make all the difference.

Get yourself checked. Don't ignore a change.