Navigating Updated Breast Imaging Guidelines: Balancing Early Detection With Radiation Risks

In April 2024, the U.S. Preventive Services Task Force changed the recommendations for imaging of non–BRCA-related breast cancer. The recommendations now state that biennial screening mammography is recommended for women ages 40 to 74, a pattern formerly suggested for women at least 50 years old.

The ACR® continues to recommend that all women have a breast cancer risk assessment by age 25. A screening benefit versus risk discussion is typically part of this assessment. The ACR also states that women at average risk for breast cancer should receive annual mammography screening starting at age 40.

A single screening mammogram poses the same risk as about 26 days of natural background radiation. This value is in comparison to a standard chest X-ray, which poses the same risk as roughly 10 days of background radiation exposure. Yet, mammograms use less radiation than an abdomen and pelvis CT, which is equivalent to 2.6 years of background radiation — or 5.1 years if repeated with and without contrast.

Despite these risks, imaging provides many benefits. Preventative screening and early detection are largely beneficial to patients in many ways, both physically and psychologically. For one, with earlier detection, patients can be treated earlier and thus benefit by increasing their chances of survival. Breast screening can also have a positive impact on women psychologically, which affects their overall well-being.

As healthcare professionals, we each carry the responsibility to advocate for our patients by encouraging preventative health screenings while helping mitigate the costs and dangers of unnecessary radiation. We should also work with our patients and consider their individual risk levels and family history. Lastly, as we continue following official guidelines and recommendations through the evolving literature, we can embrace our shared goal of helping patients, and as physicians, do no harm.