Breast cancer screening typically becomes a priority around age 40, but the American College of Radiology® (ACR®) is urging a significant shift in that timeline. According to recommendations from the ACR, every woman should receive a formal breast cancer risk assessment by age 25, a full 15 years before most begin routine mammograms. The guidance, highlighted during Breast Cancer Awareness Month, aims to identify higher-risk individuals early enough to tailor screening and potentially detect cancer sooner, when treatment is most effective.
The change reflects a growing understanding that breast cancer risk is not uniform. While annual mammography starting at 40 remains standard for women at average risk, factors such as family history, genetic mutations, and other health conditions can elevate a person’s likelihood of developing the disease. For these individuals, earlier or supplemental imaging may be warranted. One in eight women will develop breast cancer in their lifetime, and since widespread screening began, mortality has declined significantly—a testament to the power of early detection.
“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 ACR specifically emphasizes risk assessment for Black women and women of Ashkenazi Jewish descent, who may face elevated risk factors or worse outcomes. The recommendation also extends to transgender individuals, whose risk can be influenced by anatomy, hormone use, family history, genetics, and prior medical care. For these groups, a personalized approach is critical. Moreover, among Asian, Black, and Hispanic women, one-third of all breast cancers are diagnosed under age 50, underscoring the danger of relying solely on age-based screening.
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 details are available at mammographysaveslives.org.
The implications of this guidance are far-reaching. By moving risk assessment to age 25, the ACR hopes to catch aggressive or early-onset cancers that might otherwise go unnoticed until age 40. This could lead to more lives saved and a reduction in disparities that disproportionately affect certain populations. For healthcare providers, it means incorporating risk discussions into primary care visits for young adults. For patients, it’s a reminder that knowing your risk is the first step toward proactive breast health—and that conversation should start sooner than many think.
