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When to Get a Mammogram: A Guide to Risks & Timing

Written by Dr. Michael Ruscio, DC on June 6, 2025

Written by Dr. Michael Ruscio, DC on June 6, 2025 — Reviewed by Kellie Blake

• Why Mammograms Matter|
• Breast Cancer Risks|
• Recommendations for Average Risk|
• Recommendations for High Risk|
• Breast Cancer in Males|
• Types of Mammograms|
• Mammogram Risks and Benefits|
• Dense Breasts|
• Ultrasound and MRI|
• Lifestyle Help|

Understanding when to get a mammogram is essential for protecting breast health. I often discuss mammograms as part of broader conversations with clients who are navigating gut health, inflammation, and hormonal issues.

Unfortunately, breast cancer is a reality for many, but breast screening can make a significant difference in early detection and better outcomes. 

However, breast cancer screening is not one-size-fits-all. Whether you’re at average risk or higher-than-average risk, knowing when to begin screening and how often could be life-saving.

Let’s explore the evidence-based guidelines and nuanced considerations around mammography, breast cancer risk factors, and screening tools—all grounded in the most current recommendations from leading health organizations.

Why Do Mammograms and Their Timing Matter? 

Breast cancer is the most common cancer among those assigned female at birth, with about 2.3 million new cases diagnosed globally each year 1. 

Although eight out of 10 breast cancer cases occur in women over 50, younger women are being diagnosed more frequently, and their cancers can be more aggressive 1 2. This is why knowing when to start screening is so important.

Mammograms are the cornerstone of breast cancer screening, and timing is everything when it comes to catching cancer early. 

By using low-dose X-rays to detect abnormalities, mammograms have helped reduce breast cancer deaths by 40% since 1990 2. 

Although I’m not usually a big fan of excessive lab work or wellness diagnostics, I consider regular mammograms an important exception. Mammograms allow breast cancer to be found at an earlier stage, and early detection means they are easier to treat 3.

Clinical breast exams (like visually inspecting the breasts and palpating them to feel for any unusual textures or masses) aren’t reliable for screening most women, so mammograms are the gold standard 4.

What Puts You at Risk for Breast Cancer? 

Knowing your risk factors for breast cancer helps you and your health care provider decide when to start screening and how often. Breast cancer risk varies widely based on factors like age, genetics, and lifestyle. Here is a breakdown of the main risk factors 5:

• Age: Being over 40 increases your risk.
• Sex: Females face a higher risk than males.
• Personal history: If you’ve had breast cancer before, or abnormal breast cell changes, such as lobular carcinoma in situ (LCIS) or atypical hyperplasia (ADH/ALH), your risk is higher.
• Family history: A first-degree relative (parent, sibling, or child) with breast cancer doubles or triples your risk.
• Genetic mutations: BRCA1 or BRCA2 gene mutations, or having a first-degree relative with these mutations, significantly raise your risk.
• Other inherited syndromes: Examples are Li-Fraumeni syndrome and Cowden syndrome, which increase the risk of several types of cancer, including breast cancer.
• Reproductive history: Early menstruation (before age 12), late childbirth (after 30), no childbirth, or late menopause (after 55) can increase your risk.
• Hormone use: Taking estrogen or progesterone for birth control or postmenopausal symptoms may elevate your risk.
• Dense breast tissue: This may make cancer harder to detect during screening.
• Lifestyle factors: Obesity, excessive alcohol, smoking, or previous exposure to chest radiation therapy (for example, to treat a childhood cancer such as Hodgkin’s lymphoma). 

This quick table clarifies risks that are fixed (other risks—like your diet or how active you are—can be changed by your actions) 4:

A note on breast implant illness: Breast implants are not linked to an increased risk of breast cancer. But if you have implants, it’s important to tell your specialist when setting up your mammogram appointment 6 7.

What Are Mammogram Guidelines for Women with Average Risk? 

Mammogram recommendations generally focus on balancing early detection with minimizing unnecessary tests. 

For women at average risk, the American Cancer Society recommends annual screening mammograms for all women aged 45–54 (3). Here are the organization’s screening guidelines for women of different ages at average risk 4.

American Cancer Society recommendations for women at average risk of breast cancer

I encourage my female clients at average risk of breast cancer to follow the recommendations in the above table. 

That said, it’s also worth noting that official breast screening recommendations vary—not only among different U.S. organizations but also internationally. Biennial or triennial breast screening recommendations and later onset screening are also common outside the U.S. 8.  

Given that it’s wise to avoid any unnecessary radiation dose, talk to your physician or gynecologist about the best screening program for your personal needs.

What Are Mammogram Guidelines for Women at Higher Risk? 

If you’re at higher-than-average risk, your screening plan will likely be more intensive and start earlier. It may also include additional tests like breast MRI or breast ultrasound 9.

• For women at higher risk, the American Cancer Society suggests starting annual mammograms at age 30.
• High-risk individuals are usually offered both a mammogram and a breast MRI each year 4.
• If you don’t fully meet the high-risk criteria but still have some risk factors, such as dense breast tissue or abnormal breast cell changes, you may benefit from an additional screening method alongside your annual mammogram 4. 

Depending on what’s driving your increased risk, you and your doctor may decide on a personalized screening plan. For example, I’ve known women with BRCA mutations who, in consultation with their doctor, chose to start mammograms at age 25, and found this proactive step empowering. 

What Are Breast Cancer Risks for Men? 

While breast cancer is rare in men, it’s not nonexistent, making up about 1% of all breast cancer cases 10. 

• In 2018, roughly 2,550 men in the U.S. were diagnosed compared to 266,120 women 10. 
• Men with BRCA1 or BRCA2 mutations face a higher risk, with BRCA2 carriers having a 5–10% lifetime risk compared to 0.1% for non-carriers 10. 
• A family history of breast cancer also increases risk for men, especially if a first-degree relative is affected.

Symptoms in men mirror those in women, including lumps, swelling, skin changes, or nipple discharge 11. Unfortunately, men are less likely to survive breast cancer, possibly due to delayed diagnosis or other health conditions 10. 

Screening isn’t routine for men unless they’re at high risk. I encourage male clients with a family history or BRCA mutations to discuss genetic testing and screening with their health care provider.

What Are the Different Types of Mammograms? 

Mammograms come in several forms, each with its strengths. Here’s a quick overview 12:

• Screen-film mammography: A traditional X-ray printed on film.
• Digital mammography: An X-ray stored digitally for easier analysis.
• Digital breast tomosynthesis: A 3D mammography technique, FDA-approved in 2018, used in 75% of imaging centers for clearer images.
• Synthetic 2D mammography: Creates 2D images from 3D data, often used alongside 3D mammography.

When it’s available, I recommend getting a 3D mammogram as it’s more accurate, especially for those with dense breasts.

Benefits and Risks of Mammograms

Screening mammograms are a powerful tool, but they come with trade-offs. Here’s a look at the pros and cons 13: 

Is Radiation from Mammography a Concern?

High doses of radiation (over 100 mGy) can increase the risk of certain cancers, including breast cancer. However, a single screening mammogram uses a much lower dose—about 3 mGy, which is roughly the same as six weeks of natural background radiation (radiation we are all exposed to from natural sources).

Bottom line? The risks to your health from the radiation used in mammograms are extremely low compared to the number of lives saved through screening—an estimated 50–75 lives saved for every potential life lost.

Even so, you should aim for the minimum amount of screening necessary for your risk level. Yearly mammograms between the ages of 40 and 75 add the equivalent of 4 years of background radiation to your lifetime exposure. That’s perfectly acceptable as long as the risk-benefit ratio stays in your favor. But if your breast cancer risk is very low, having more mammograms than necessary could add to your overall risk.

I can’t stress enough how important it is to talk to your doctor or gynecologist about what the best screening strategies are for you.

How Do You Know If You Have Dense Breasts? 

Dense breasts are common, affecting nearly half of women over 40 12. Breasts are considered dense if they have more glandular and fibrous tissue than fat. 

You can’t feel dense breast tissue—it’s only visible on a mammogram. Radiologists classify breast density into four categories, A–D, where A is mostly fatty and D is extremely dense 12.

What’s the Problem with Dense Tissue?

Dense breast tissue slightly raises breast cancer risk but also makes mammograms harder to read, as both dense tissue and tumors appear white on X-rays 12. 

Providers must inform you by law if you have dense breasts, so always review your report with your health care provider.

Ultrasound and MRI: Do You Need Additional Screening?

If you have a high breast cancer risk or if your mammogram report notes dense breasts, you may need additional testing like an MRI or breast ultrasound.

MRIs 

Breast MRIs use magnetic fields rather than X-rays to produce a detailed image of breast tissue. 

Breast MRIs are only recommended if you are at high risk of breast cancer. If your healthcare provider determines your risk is less than 15%,  MRI screening is NOT recommended 4.

Though MRIs don’t use X-rays, they still have potential risks. These include false-positive results, allergic reactions to contrast dyes used for MRI images, and the possibility of complications for people with kidney problems.

Ultrasounds

Ultrasound scans, which are less expensive than MRIs, use sound waves to look at the inside of your breasts. Breast ultrasound isn’t used to screen for cancer, but is most often used to find out if a problem found by a mammogram is a cyst or a solid tumor.

Ultrasound may also be used in addition to a mammogram if 14:

• You have very dense breast tissue, because a mammogram may not be able to see through the tissue.
• You are pregnant. Mammograms use radiation, but ultrasound does not. This makes it safer for the baby.
• You need a needle biopsy. Ultrasound can be used to guide the needle to the changed tissue.
• You have a cyst that needs to be drained.
• You have breast implants, because an ultrasound can show leaks or ruptures.

What About Thermography?

Thermography, also known as digital infrared thermal imaging (DITI), is an imaging test that uses an infrared camera to detect temperature differences and blood flow near the surface of the breast.

Thermography has gained popularity, particularly within the functional medicine community, with some claiming it can identify “hot spots” that may indicate cancer or other abnormalities 15. 

However, thermography is not approved or recommended by the American Cancer Society or other major medical organizations for breast cancer screening.

If you’re curious about thermography, it’s advisable to use it only in combination with mammograms, not as a replacement. This is because current research does not support its effectiveness or reliability in detecting breast cancer 16.

Reducing Your Breast Cancer Risk: Lifestyle Supports

While many breast cancer risk factors—like age, sex, and family history—are beyond your control, others are within your power to change. For women at average risk, adopting healthy habits can play a meaningful role in reducing overall risk 17.

Maintain a Healthy Weight

Weight gain in adulthood and being overweight after menopause are linked to a higher risk of breast cancer. Strive to reach and maintain a healthy weight by balancing your diet with regular physical activity. Many of my clients report managing their weight and feeling energized on a Paleo-style diet. However, there’s not one diet that works for everybody, so you should do what works for you. A registered dietitian can provide valuable guidance when it comes to finding a diet and plan to fit your needs. 

Be Physically Active

Regular exercise is consistently associated with a lower risk of breast cancer 18 19. Aim for at least 150 to 300 minutes of moderate activity (like brisk walking) and for 75–150 minutes of vigorous activity (like running or cycling) each week. The more you can do—safely and sustainably—the better, but don’t be discouraged if you need to start small with physical activity. A 2023 study found that short, 1-2 minute bursts of vigorous movement throughout the day (like climbing the stairs) can help lower cancer risk 20.

Limit Alcohol

Even small amounts of alcohol can raise your breast cancer risk 21. The safest choice is not to drink at all, but if you do, limit it to no more than one drink per day.

Consider Breastfeeding

Breastfeeding for at least 12 months after childbirth may offer additional protection against breast cancer, along with other health benefits for you and your baby 22 23.

Review Menopausal Hormone Use

If you’re considering hormone therapy to manage menopausal symptoms, talk to your doctor about non-hormonal alternatives. Hormone use after menopause may increase breast cancer risk 24.

Eat for Overall Health

Although a direct link between diet and breast cancer risk remains unclear, healthy eating seems to play a role in cancer prevention. Studies show that eating plenty of fruits and vegetables, while limiting ultra-processed foods, saturated fats, and processed meat, appears to boost breast cancer prevention 25 26. Research seems to point to the Mediterranean diet as one eating pattern that may protect against breast cancer 25.

Making Sense of Mammograms

Navigating breast cancer screening can be complicated, but you can get the right schedule for you by discussing your risk factors with your health care provider.

If you’re unsure when to get your first mammogram, use the American Cancer Society guidelines as a starting point. For average-risk women, that means starting at 40 with annual screening. High-risk women may need to begin at 30 with mammograms and supplementary screening.

Breast health can be influenced by lifestyle factors such as what you eat and drink and how active you are, so consider how these intersect with your screening plan. 

For more tips on staying proactive about your health, subscribe to the Dr. Ruscio Newsletter.

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