Posted on May 18, 2023

By The Breast Cancer Action Team

On Tuesday, May 9 the U.S. Preventive Services Task Force (USPSTF) put forth a significant shift in their mammography screening guidelines, suggesting a decade-earlier date start for routine screening at age 40, rather than the age of 50 as outlined in previous guidelines. 

According to Medscape, “Two major factors prompted the change, explained [USPSTF member John Wong, MD]. One is that more women are being diagnosed with breast cancer in their 40s. The other is that a growing body of evidence showing that Black women get breast cancer younger, are more likely to die of breast cancer, and would benefit from earlier screening.” 

Breast Cancer Action holds two relevant stances with deep conviction: 

  1. We need unbiased, patient-centered, and data-driven solutions specific to unique demographics and communities like young womxn and Black folx, due to stark rates of breast cancer disparities in diagnosis, access to treatment, and mortality. 
  2. Mammography screening is not the tool that will get us there. 

Problems of Mammography Screening

Breast Cancer Action has long been critical of the potential harms from routine breast cancer screening, including over-diagnosis and over-treatment, and these harms may have disproportionate impacts on young womxn¹ and Black womxn, and especially for those who hold intersecting identities of being both young and Black.  

This is due to the fact that mammography has reduced sensitivity in women² with high breast density.³ Given that breast tissue is likely to be denser prior to menopause⁴ and Black women are more likely to have dense breasts than their counterparts of other demographics,⁵ it could be argued that mammography screening is less likely to be effective for these groups.  

So why is USPSTF recommending mammography for younger folx, and as a solution to breast cancer disparities? Because it’s all we have. Why is it all we have, after all these years?

We need to step back from the myopic view of mammography screening as the best and only tool in addressing breast cancer, and instead advocate for large-scale, structural public health changes.  

BCAction has said this for years and we’ll say it again: mammography screening does not and cannot prevent or treat breast cancer. And too often results in over-diagnosis, and subsequent over-treatment, especially in younger people with dense breast tissue, and it is not good enough as our primary screening tool in the work to end breast cancer. To truly end breast cancer, we must focus on eliminating toxic exposures in our environment as a primary prevention strategy, while simultaneously improving our screening tools.  

Organizations like USPSTF can and must join us in putting forth solutions beyond mammography screening.  


Can we expect an organization that makes screening recommendations to think beyond mammography screening? Yes, as evidenced by their own recommendations, which begin to move toward advocating for more research and data.

There are some silver linings coming out of this seemingly-backwards recommendation. 

  1. Breast cancer screening should be based on individual risk guidelines and conversations rooted on trust between people and their providers. For those that do need mammography screening based on individual risk factors, being within the scope of screening guidelines like those of USPSTF is one of the primary ways to get insurance to cover the costs. Because we’re operating from a broken, exclusionary, for-profit healthcare system, whether or not we think mammography screening should be recommended in this way (we don’t), we want all necessary mammography to be covered by insurance.  
  2. USPSTF is finally calling for studies related specifically to Black women, saying there’s insufficient data so far to determine the cause of their increase in mortality rates. This is long overdue and we support funding and research being dedicated to addressing the disparities within the breast cancer crisis. We support customized, culturally competent and humble solutions unique to each community facing disproportionate breast cancer rates, but mammography screening is an inadequate solution for this. Addressing the disparate diagnosis and mortality rates for Black people, Immigrant communities, and other communities most directly impacted through large-scale public health solutions will benefit all communities. 

We are able to hold this nuance that breast cancer screening tools MUST be improved, and this USPSTF change, including addressing disparities, can result in positive changes, like increased insurance coverage and more equitable research.   

The Science: Breast Density & Disparities

 Dense breast tissue can make it more challenging to detect breast abnormalities on mammograms, as both dense tissue and cancerous masses appear white on the images, making it harder to differentiate between them. And breast density can vary within racial and ethnic groups, and within younger age groups, and individual variations exist regardless of racial or ethnic background. The increased prevalence of dense breast tissue in certain racial groups, particularly in Black folx, may contribute to the limitations of mammography as a screening tool in these groups, potentially leading to higher rates of false-negative results.   

Recognizing the racial disparities and inequities in breast density can help inform healthcare providers and policymakers to consider alternative screening methods or patient-centered comprehensive strategies that may improve early detection in people with dense breasts, particularly in higher-risk groups.  

It is crucial to consider breast density along with other risk factors and individual health profiles when developing personalized breast cancer screening plans. Yes, it’s positive that USPSTF is recognizing disparities and that they are calling for more research, but in the meantime, providers will continue to push more mammography for younger people and for BIPOC folx. Thus, this has to be an informed decision, made by the people working with their providers, because there are a number of concerning factors to take into account considering mammography. 

These factors include, but are not limited to:  

  • False negatives: Mammography has a significant false-negative rate, which means that it can miss detecting breast cancer in some cases. This can lead to delayed diagnosis and treatment, reducing the effectiveness of mammography as a prevention tool.  
  • False positives: On the other hand, mammography can also produce false-positive results, leading to unnecessary anxiety and further invasive procedures such as biopsies, which can be emotionally and physically taxing.  
  • Limited sensitivity in certain populations: As stated above, mammography’s effectiveness is reduced in certain groups, such as younger people with dense breast tissue. 
  • Overdiagnosis and overtreatment: Mammography can lead to overdiagnosis, which means detecting small tumors that may never become clinically significant. This can result in unnecessary treatments like surgery, radiation, and chemotherapy, with associated risks and potential harm to patients. 
  • Radiation exposure: Mammography involves ionizing radiation, which poses a small but potential risk of causing cancer itself. Frequent mammograms over a person’s lifetime can increase the cumulative radiation dose, potentially outweighing the benefits of early detection.  
  • Limited detection of aggressive cancers: Mammography is less effective in detecting aggressive breast cancers, such as those with fast growth rates or tumors in younger people. These types of cancers may require alternative screening methods or additional diagnostic tests for accurate detection.  
  • Cost and accessibility: Mammography can be expensive, making it less accessible to under-resourced communities. Limited availability and long waiting times for screening appointments can further hinder its widespread use as a screening tool for breast cancer—and this of course is if the patient makes the decision that mammography is their best choice for their individual plan of care.  
  • Emotional and psychological impact: Mammography can induce anxiety and fear due to the anticipation of the screening process and waiting for results. This psychological burden can discourage some people from participating in regular screenings, compromising the potential benefits of mammography as a prevention tool. 
  • Alternative screening methods: Emerging technologies such as MRI (magnetic resonance imaging) and ultrasound are showing promise in detecting breast cancer, particularly in higher-risk groups. These alternative methods may offer improved accuracy and reduced limitations compared to mammography. 
  • Emphasis on early detection rather than prevention: While mammography focuses on early detection, the emphasis on screening does not address the underlying risk factors and causes of breast cancer. And, mammography certainly will not end the breast cancer crisis. More emphasis should be placed on prevention strategies such as eliminating toxic exposures in our environment as a primary prevention strategy, while simultaneously improving our screening tools. 

It may be too much for us to expect expansive, health justice solutions beyond mammography screening from an agency whose role it is to make mammography screening recommendations.  

But herein lies exactly the problem and the solution: our long-term, comprehensive visioning for how to address and end breast cancer should not come from those with too-narrow a focus on screening instead of prevention, a priority of profit over public health, or conflicts of interest from within the Breast Cancer Industry 

We need unbiased, people-centered advocates in this work with justice-oriented visions and values, who can proffer systemic solutions. Join us in working to address and end breast cancer in this way, together.   

¹ In this piece, BCAction uses “young women” to mean women under 50, or pre-menopausal women, given USPSTF’s addition of the age 40-49 demographic as now being recommended routine mammography screening.  

² BCAction’s language preference is to use the more inclusive “womxn” over “women,” but when citing other data that uses the category of “women,” we do not alter the language.

³ Brunetti et al. (2022). A Prospective Comparative Evaluation of Handheld Ultrasound Examination (HHUS) or Automated Ultrasound Examination (ABVS) in Women with Dense Breast. Diagnostics (2075-4418), 12(9).

Several studies have found age to be a strong determinant of breast density. Dense breast tissue decreases as women get older. Compared to women who have gone through menopause, dense breasts are more common in younger women. Read more about breast density here: