For decades, the breast cancer screening conversation has typically started around age 40, when annual mammography is recommended for women at average risk. But new guidance from the American College of Radiology (ACR) argues that one of the most important discussions about breast health should begin much sooner: a formal breast cancer risk assessment by age 25.
The recommendation, published in the Journal of the American College of Radiology, reflects a growing understanding that breast cancer risk is not uniform. While widespread screening has helped drive a significant decline in breast cancer mortality through earlier diagnosis and treatment, the ACR says a one-size-fits-all approach misses people who could benefit from earlier or supplemental imaging. According to the ACR's recommendations, all women should undergo a risk assessment by age 25, with particular emphasis on Black women and women of Ashkenazi Jewish descent, who may face elevated risk factors or worse outcomes.
"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 implications extend beyond individual patients. One in eight women will develop breast cancer in their lifetime, and certain populations are diagnosed at younger ages. Among Asian, Black, and Hispanic women, one-third of all breast cancers are diagnosed under age 50. That statistic underscores why evaluating individual risk—rather than relying solely on age-based guidelines—could lead to earlier detection when treatment is most effective.
Risk assessment is also important for transgender individuals, whose breast cancer risk can be influenced by anatomy, hormone use, family history, genetics, and prior medical care. Providers can use these factors to develop individualized screening recommendations.
For patients wondering how to start the conversation, the ACR points to Mammography Saves Lives, an educational initiative that provides information about breast cancer risk factors, breast density, screening recommendations, and questions to discuss with healthcare providers. Additional resources are available at mammographysaveslives.org.
As Breast Cancer Awareness Month highlights early detection, the ACR's message is clear: knowing your risk by age 25 can guide future screening decisions and, for some, may lead to earlier detection when it matters most.
