Breast cancer is the second most common cancer and the second most common cause of cancer death for women in the United States. But the American College of Radiology reports that mammograms have reduced breast cancer mortality by 40% since 1990. Some groups, such as the American Cancer Society, American College of Radiology and Society of Breast Imaging have been recommending for women to start mammograms in their forties.

Previously, the task force has recommended that women in their 40s make an individual decision about when to start screening based on their health history and preferences; however, after an increase in breast cancer diagnosis among young women and high rates among Black women, in particular, the task force is calling for change—one that could result in 19% more lives being saved.

“Women in their 40s account for 20% of all breast cancers. Early detection with annual mammograms is hugely impactful for this age group, as their tumors tend to be the more aggressive and they have the most potential years of life,” explains Dr. Harriet Barofsky, medical director of breast imaging, Hackensack Meridian Riverview and Bayshore Medical Centers in New Jersey. “The benefits of screening, such as halting the natural progression of cancer, increasing treatment options that are well tolerated and saving lives far outweigh the risks of false positives, which can be resolved with additional imaging and biopsies.”

According to the task force, Black women are 40% more likely to die of breast cancer than White women and too often get deadly cancers at younger ages. The new guidelines for screening aim to eliminate this inequity.

“Disparities in outcomes of breast cancer for Black women occur at all points across the care spectrum: access to screening, prompt diagnosis, prompt initiation of treatment, access to equitable treatment/best practices, access to clinical trials,” says Dr. Toma Omofoye, a breast radiologist and associate professor in the Department of Breast Imaging at The University of Texas MD Anderson Cancer Center in Houston, Texas. “Also, racism and racial inequities lead to toxic environments and stress which increase risk not just of developing cancer but developing more aggressive tumor types. Screening early and often is just one, but a very important, part of addressing disparities in Black women.”

Additional research is needed to determine how to best address health disparities faced by Black, Hispanic, Latina, Asian, Native American, and Alaska Native women, especially as it relates to equitable followup post-screening. The task force is also looking into whether women with dense breast tissue need to have an additional screening with breast ultrasound or MRI and what are the benefits and risks of screening women older than 75.

“We know that women with dense breasts are at higher risk of breast cancer and, unfortunately, mammograms do not work as well for them,” task force member Dr. John Wong said in a press release about the recommendation. “What we don’t know yet, and what we are urgently calling for more research on, is whether and how additional screening for women with dense breasts might be helpful, including through ultrasound, breast MRIs, or something else.”