Summary

The 2024 USPSTF recommends biennial screening mammography for all women aged 40 to 74 years (Grade B), using either digital mammography or digital breast tomosynthesis. This updates the 2016 statement, which had recommended individualized decision-making for women in their 40s; universal screening starting at 40 was driven by rising breast cancer incidence in women 40-49 and modeling showing additional deaths averted, particularly for Black women. Evidence remains insufficient (I statement) for screening women ≥75 years and for supplemental ultrasound or MRI in women with dense breasts.

Key Recommendations

Screen all women aged 40-74 with biennial mammography (Grade B).
Start screening at age 40 rather than individualizing the decision for women in their 40s (key change from 2016).
Use either digital mammography or digital breast tomosynthesis (DBT) as the primary screening modality.
Screen every 2 years; biennial has more favorable benefit-to-harm balance than annual.
Insufficient evidence to recommend for or against screening mammography in women ≥75 years (I statement); use clinical judgment.
Insufficient evidence to recommend for or against supplemental ultrasound or MRI in women with dense breasts and otherwise negative mammogram (I statement).
Recommendation applies to cisgender women and all persons assigned female at birth ≥40 at average risk, including those with a first-degree relative with breast cancer or dense breasts.
Does NOT apply to women with BRCA1/BRCA2 or other high-risk genetic syndromes, prior high-dose chest radiation at young age, or prior breast cancer/high-risk breast lesion on biopsy.
Ensure equitable and timely follow-up of abnormal mammograms and effective treatment, particularly for Black women who have ~40% higher breast cancer mortality.

Thresholds & Doses

Start screening: age 40
Stop screening: age 74 (insufficient evidence ≥75)
Interval: every 2 years (biennial)
Modalities: digital mammography or DBT (with synthetic or digital 2D)
Modeling (biennial 40-74 vs 50-74, per 1000 women): ~1.3 additional breast cancer deaths averted overall; ~1.8 additional deaths averted in Black women
Modeling harms (biennial 40-74, per 1000 women): ~1376 false-positives, ~14 overdiagnosed cases over lifetime
Breast cancer mortality: ~40% higher in Black vs White women
Dense breasts: occur in ~40-50% of screened women; FDA mandates breast density notification starting Sept 2024

Citations

Recommendation Summary table — age range, interval, and grades
Clinician Summary / What’s new — change from 2016 (individualized 40-49 → universal biennial 40-49)
Practice Considerations: Screening Tests — digital mammography and DBT both acceptable
Practice Considerations: Screening Interval — biennial favored over annual
Patient Population Under Consideration — exclusions (BRCA, prior chest RT, prior breast cancer/high-risk lesion)
Table 2 — modeling estimates of benefits/harms biennial 40-74 vs 50-74
Disparities section — Black women 40% higher breast cancer mortality
I statements — women ≥75 and supplemental screening for dense breasts