Breast cancer incidence is rising among young women.

Because of this, the notoriously critical U.S. Preventive Services Task Force (USPSTF) has revised its recommendations for breast cancer screening to say women at average risk for breast cancer should begin at 40, not 50, as previously suggested.

About 1 in 8 women in the United States are going to develop an invasive breast cancer in the course of their life. In 2023, an estimated 297,790 new cases of invasive breast cancer will be diagnosed in women and about 43,700 women will die this year from breast cancer.

Breast cancer is not one-size-fits-all and different cancers develop in various age groups. Cancer morphology that develop in premenopausal women tend to differ from those diagnosed in older women. Among the younger age group, the type of breast cancer tends to be more aggressive, diagnosed at a higher stage, with fewer preinvasive lesions.

The USPSTF and breast specialists have been at odds since 2009 when the USPSTF recommended mammograms to begin at 50, citing concern there may be more risk than benefit in screening women under 50. However, in the last 14 years, international data show a rise in breast cancer in women 19-49 years, with early detection and intervention remaining the best way to increase survival for these women.

The risk of developing breast cancer is multifactorial including family history and genetic mutations (BRCA 1/2), which tend to result in cancers in younger women. Additional factors specific to American women include rising levels of obesity, and lower fertility and breastfeeding rates. Exposure to sex hormones (early menarche, late menopause, older age at first birth, hormone replacement therapy and hormonal contraception) may also have an effect.

Breast screening guidances for average risk, asymptomatic women still remain confounded with various existing recommendations. The USPSTF now suggests beginning screening mammograms at 40 and continuing biennially (every other year). The American Cancer Society says women 40-44 should decide themselves whether to get a mammogram and at 45 to get a mammogram every year after. The American College of Radiology and Society of Breast Imaging encourage annual mammograms beginning at 40.

Cancer screening recommendations change if known risk factors such as genetic mutations, strong family history, personal history of breast cancer and prior mantle radiation for lymphoma exist which often warrant earlier age of screening commencement.