Ordering a mammogram for a patient under 40 years old is generally not recommended for average-risk women. However, it is justified in certain high-risk scenarios.

For women at higher-than-average risk, the American College of Radiology (ACR) recommends annual mammographic screening starting at age 30 for those with a genetics-based increased risk (e.g., BRCA1/2 mutation carriers) or a calculated lifetime risk of 20% or more, as well as for those with a history of chest radiation therapy before age 30.[1-2] Additionally, the ACR suggests that women with a personal history of breast cancer, atypical ductal hyperplasia (ADH), or lobular carcinoma in situ (LCIS) diagnosed before age 40 should begin annual screening at the time of diagnosis.[1-2]

For average-risk women, the American College of Physicians (ACP) and other guidelines recommend initiating discussions about mammography screening at age 40, with the decision to screen based on individual risk factors, patient preferences, and a shared decision-making process.[3-4] The potential harms, such as false positives and overdiagnosis, often outweigh the benefits in women aged 40 to 49 years, making individualized decision-making crucial.[3]

In summary, mammograms are typically recommended for women under 40 years old only if they are at high risk for breast cancer. For average-risk women, screening discussions generally begin at age 40, with actual screening starting between ages 40 and 50 based on individual risk and preferences.

References

1. Breast Cancer Screening in Women At Higher-Than-Average Risk: Recommendations From the ACR.

Monticciolo DL, Newell MS, Moy L, et al. Journal of the American College of Radiology : JACR. 2018;15(3 Pt A):408-414. doi:10.1016/j.jacr.2017.11.034.

2. ACR Appropriateness Criteria Breast Cancer Screening.

Mainiero MB, Moy L, Baron P, et al. Journal of the American College of Radiology : JACR. 2017;14(11S):S383-S390. doi:10.1016/j.jacr.2017.08.044.

3. Screening for Breast Cancer in Average-Risk Women: A Guidance Statement From the American College of Physicians.

Qaseem A, Lin JS, Mustafa RA, et al. Annals of Internal Medicine. 2019;170(8):547-560. doi:10.7326/M18-2147.

4. Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society.

Oeffinger KC, Fontham ET, Etzioni R, et al. Jama. 2015;314(15):1599-614. doi:10.1001/jama.2015.12783.