Intended for healthcare professionals


Breast cancer screening from age 40 in the US

BMJ 2024; 385 doi: (Published 24 June 2024) Cite this as: BMJ 2024;385:q1353
  1. Katy JL Bell, professor12,
  2. Brooke Nickel, senior research fellow1 2,
  3. Thanya Pathirana, senior lecturer2 3,
  4. Mitzi Blennerhassett, patient activist4,
  5. Stacy Carter, professor2 5
  1. 1Sydney School of Public Health, University of Sydney, NSW, Australia
  2. 2Wiser Healthcare Research Collaboration, Australia
  3. 3School of Medicine and Dentistry, Griffith University, Sunshine Coast, QLD, Australia
  4. 4Patient representative, York, UK
  5. 5Australian Centre for Health Engagement, Evidence and Values, School of Health and Society, University of Wollongong, NSW, Australia
  1. Correspondence to: K J L Bell katy.bell{at}

The new recommendation could cause more harm than benefit

The US Preventive Services Task Force has updated its recommendation for the age when all women should start mammography screening, lowering it from 50 to 40.1 This change immediately affects more than 20 million American women and other people assigned female at birth who are aged 40-49,2 with repercussions far beyond the US.

Such a momentous change should reflect new randomised trial evidence or concerning cancer mortality trends. But no such trial evidence was found in the commissioned evidence report,3 and breast cancer mortality has been decreasing, especially among women under 50.4 The new recommendation seems to be based on two, inter-related, considerations. The first is recognition of the inequality in breast cancer mortality between Black and white US women, and a commitment to reduce this. The second is statistical modelling of a hypothetical population that found starting screening at 40 would reduce breast cancer mortality, especially among Black women.5

The need to make health policy and systems antiracist and more equitable is urgent and compelling. But there …

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