The American College of Radiology (ACR) now advises that women should undergo a formal breast cancer risk assessment by age 25, a significant shift from the conventional practice of beginning screening discussions at age 40. The recommendation, published in the Journal of the American College of Radiology, aims to identify individuals at elevated risk who may benefit from earlier or supplemental imaging, according to the ACR’s recommendations.
Breast cancer remains one of the most commonly diagnosed cancers in the United States, and early detection is a proven tool for improving survival. Since widespread screening began, breast cancer mortality has declined significantly, reflecting the life-saving potential of earlier diagnosis and treatment. While annual mammography starting at age 40 is recommended for women at average risk, the ACR stresses that risk is not uniform. Family history, genetic mutations, and other health factors can substantially increase a person’s likelihood of developing the disease, making age-based screening alone insufficient.
One in eight women will develop breast cancer in their lifetime. The ACR’s guidance places particular emphasis on Black women and women of Ashkenazi Jewish descent, who may face elevated risk factors or worse outcomes. It also highlights the importance of risk assessment for transgender individuals, whose breast cancer risk can be influenced by anatomy, hormone use, family history, genetics, and prior medical care. For these populations, a personalized screening strategy can be developed before cancer develops.
“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 urgency of earlier risk evaluation is underscored by data showing that among Asian, Black, and Hispanic women, one-third of all breast cancers are diagnosed under age 50. Relying solely on age-based screening recommendations may therefore miss critical opportunities for earlier detection in these groups.
To help individuals take the first step, the ACR offers Mammography Saves Lives, an educational initiative providing information on breast cancer risk factors, breast density, screening recommendations, and questions patients can discuss with their healthcare providers. Additional resources are available at mammographysaveslives.org.
Breast Cancer Awareness Month serves as a reminder that learning your risk by age 25 can provide valuable information to guide future screening decisions and, for some, lead to earlier detection when treatment is most effective.
