For decades, the conversation about breast cancer screening has centered on age 40, when annual mammography typically begins for women at average risk. However, recommendations from the American College of Radiology (ACR) now call for a formal breast cancer risk assessment by age 25. This shift matters because it moves the focus from a uniform age-based approach to a personalized one, potentially catching cancer earlier in those who need it most.
Breast cancer remains one of the most commonly diagnosed cancers in the United States, and early detection is a proven tool for improving outcomes. Since widespread screening began, mortality has declined significantly. While annual mammography starting at 40 is still advised for average-risk women, risk is not identical for everyone. Family history, genetic mutations, and other health factors can elevate a person’s likelihood of developing the disease, warranting earlier or supplemental screening.
The numbers underscore the urgency. One in eight women will develop breast cancer in their lifetime. The ACR particularly emphasizes Black women and women of Ashkenazi Jewish descent, who may face elevated risk factors or worse outcomes. Among Asian, Black, and Hispanic women, one-third of all breast cancers are diagnosed under age 50. This means relying solely on age-based screening could miss cancers in younger women who are not yet eligible for routine mammograms.
“Breast cancer screening is not a one-size-fits-all approach,” said Stamatia Destounis, MD, FACR, chair of the American College of Radiology Breast Imaging Commission. “A risk assessment by age 25 can help identify those who may benefit from earlier screening or supplemental imaging. Understanding your personal risk allows people and their healthcare providers to make informed decisions based on their unique circumstances.”
The implications extend beyond cisgender women. Risk assessment is also important for transgender individuals, whose breast cancer risk can be influenced by anatomy, hormone use, family history, genetics, and prior medical care. Providers can use these factors to tailor screening recommendations to each person’s specific profile.
To help people take the first step, the ACR offers Mammography Saves Lives, an educational initiative providing information on risk factors, breast density, screening recommendations, and questions to discuss with healthcare providers. Additional resources are available at mammographysaveslives.org. As Breast Cancer Awareness Month highlights, knowing your risk by 25 can guide future screening decisions and, for some, lead to earlier detection when treatment is most effective.
This announcement matters because it challenges the status quo of waiting until 40 to think about breast cancer risk. By identifying higher-risk individuals a decade and a half sooner, healthcare providers can develop personalized strategies before cancer develops. For populations facing disparities in diagnosis and outcomes, this proactive approach could be a lifeline. It also empowers individuals to advocate for themselves, asking about risk assessment at a young age and ensuring their screening plan matches their actual risk, not just their age.
