Mammography: at what age and how often should you have the exam?

On the eve of the start of Pink October, the Ministry of Health announced that women aged 40 to 49 will have access to mammograms through the Unified Health System (SUS) even without signs or symptoms of cancer. This age group accounts for 23% of cancer cases, and early detection increases the chances of a cure. The measure is part of a series of Ministry of Health initiatives aimed at improving diagnosis and care, with the launch of mobile services in 22 states through Agora Tem Especialistas.

According to the Ministry, the recommendation for women over 40 is that the exam be performed on demand, in consultation with a healthcare professional. Furthermore, another measure announced concerns the expansion of the age range for active screening, in which preventive mammograms should be performed every two years. The maximum age, previously limited to 69, will be extended to 74.

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This is the second time that the discussion surrounding the starting age and frequency of mammograms has been highlighted in 2025. Earlier this year, the National Supplementary Health Agency (ANS), responsible for regulating health plans in Brazil, sparked controversy by launching a public consultation on best practices in oncology medical services. Among the proposals in the text was an increase in the minimum age for mammograms, which should be biannual, starting at age 50. This is despite the fact that several experts and medical organizations recommend that women at normal risk—that is, without a family history of cancer, previously detected genetic alterations, or suspicious symptoms—begin screening ten years earlier, at age 40, and repeat it once a year.

The issue sparked outrage, criticism, and countless questions at the time. Given the debate, the ANS granted a one-month deadline for organizations opposing the age range proposed in the new oncology best practices program to submit a report with scientific evidence on the matter.

In response, the Brazilian College of Radiology and Diagnostic Imaging (CBR), the Brazilian Society of Mastology (SBM), the Brazilian Society of Clinical Oncology (SBOC), the Brazilian Federation of Gynecology and Obstetrics (Febrasgo), and the Brazilian Federation of Philanthropic Institutions for Breast Health Support (Femama) jointly produced a document compiling data and studies that support the importance of expanding screening mammography for women aged 40 to 74. According to the report, 40% of women develop breast cancer in this age group, and 22% of deaths from the disease also occur in women before age 50.

After analyzing the document, the ANS (National Health Agency) heeded the request of medical institutions and public sectors and changed its guidance. The agency announced that screening should indeed be widely conducted for women over 40, so that health plans can receive certification for best practices in oncology.

After all, what is the right age to start having mammograms?

The answer may vary, depending on the guidelines of different health institutions, in addition to each person's risk of developing breast cancer throughout their life, according to mastologist Annamaria Massahud Rodrigues dos Santos, deputy secretary of the Brazilian Society of Mastology and member of the Brazilian Federation of Gynecology and Obstetrics (Febrasgo) and the American Society of Clinical Oncology (ASCO).

Until the new announcement, the Ministry of Health recommended that women at normal risk of developing breast cancer begin having mammograms every two years after age 50. This recommendation, according to breast specialist Afonso Nazário of HCor – Hospital do Coração (SP), was based on European guidelines. "We know that this population is different from the Brazilian population. Research on the average age of breast cancer patients in Europe shows that the average there is much higher than in Brazil, hovering around 60 to 62 years old. In other words, for Europe, it makes sense to begin screening at 50," notes Nazário, who is also Head of the Mastology Department at the Paulista School of Medicine at the Federal University of São Paulo (EPM-Unifesp).

The Brazilian Society of Mastology, Febrasgo and the Brazilian College of Radiology (CBR), in turn, already recommended annual screening from the age of 40 to 74, for women with a usual population risk of breast cancer.

But cancer doesn't measure age and can be diagnosed even in younger people.

For women at high risk, mammography screening may be recommended as early as age 30. "Women with a family history of breast cancer or other genetic factors that increase risk (such as mutations in the BRCA1 or BRCA2 genes) may be encouraged to have mammograms earlier, sometimes in conjunction with breast MRI," emphasizes the mastologist. "The goal is to include a greater number of women at risk for developing cancer so that it can be detected before signs or symptoms are identified," adds Annamaria.

More drugs to fight breast cancer

The Ministry of Health also announced that, starting in October, the Unified Health System (SUS) will make new medications available for the treatment of breast cancer. One of them is trastuzumab emtansine, indicated for women with breast cancer who still show signs of the disease even after the first phase of chemotherapy treatment before surgery.

The other group are cyclin inhibitors (abemaciclib, palbociclib and ribociclib), recommended for patients with advanced or metastatic breast cancer, when the disease has already spread to other parts of the body, and who have positive and negative hormone receptors.