Four organizations. Four different answers.

Hi —

October turns everything pink, and somehow the most practical question still doesn't get a straight answer: when should you actually start getting mammograms?

The reason is that the major organizations disagree. Not subtly — genuinely.

1. This month: breast cancer screening

What the guidelines actually say

U.S. Preventive Services Task Force: mammography every two years, ages 40 to 74. They concluded the evidence is insufficient to make a recommendation for women 75 and older.

American Cancer Society: optional annual screening from 40 to 44. Annual from 45 to 54. From 55, every two years, or annually if you prefer. Continue as long as you're in good health with a life expectancy of ten or more years.

American College of Radiology and American Society of Breast Surgeons: annual, starting at 40.

ACOG: offer screening starting at 40, every one or two years, decided through shared decision-making with your clinician.

So what do you do with that?

Every major group now agrees screening should be available starting at 40. That's the part that's settled, and it's a change — the USPSTF moved its recommendation down from 50 in 2024.

Where they diverge is frequency, and that disagreement is real rather than a technicality. Annual screening catches more cancers earlier. It also produces more false positives, more callbacks, and more biopsies that turn out to be nothing. Reasonable people weigh those differently, and no guideline can weigh them for you.

What actually changes the answer for you

Family history, particularly a first-degree relative with breast cancer. Known genetic mutations. Prior chest radiation. Dense breast tissue. Race — Black women are more likely to be diagnosed young and more likely to die of breast cancer, which is part of why the starting age moved.

If any of those apply, average-risk guidelines aren't your guidelines, and the conversation should start earlier than 40.

What to ask at your next visit

What's my actual risk category? Given that, do you recommend annual or every two years — and why that one? Are my breasts dense, and does that change anything for me?

2. On Instagram this month

This month's feed runs alongside what's above, spread across the month rather than all at once:

When to start mammograms — and why the guidelines conflict. The same breakdown as above, as a carousel, ending with three questions to bring to your next visit.

Dense breasts: what the notification letter actually means. What's below, expanded — and this month's quiz question.

A quiet post for Pregnancy and Infant Loss Remembrance Day, October 15. No quiz, no sell — just space held for anyone carrying a loss the world never saw.

Perimenopause symptoms in your late 30s and 40s. Why it rarely starts with hot flashes, timed to World Menopause Day (Oct 18).

Follow along: instagram.com/arteandcera

3. What's new in women's health

The FDA removed hormone therapy's black-box warning. In November 2025, the FDA began removing the boxed warnings for cardiovascular disease, breast cancer, and probable dementia from estrogen-containing HRT products — warnings that had been in place since the early 2000s, based on a study where the average participant was 63, over a decade past typical menopause onset. The FDA's updated guidance: starting HRT within 10 years of menopause onset, or before age 60, is when the benefit-risk picture looks most favorable. One warning stays in place — endometrial cancer risk for systemic estrogen taken without a progestin. This doesn't mean HRT is right for everyone, or risk-free. It means two decades of blanket caution are being replaced with guidance specific to timing and individual risk — worth revisiting if you were told years ago it wasn't an option for you.

4. Question of the month

Last month's answer: PMOS (formerly PCOS) — roughly 1 in 10 women of reproductive age.

This month: Roughly what share of women have dense breast tissue?

A. About 1 in 10
B. About 1 in 4
C. About half
D. About 3 in 4

Answer in November's issue.

Coming next month The symptoms women are most reluctant to bring up — and the one most likely to be dismissed as just part of having had a baby.

Thanks for reading. If something here was useful, forward it to someone who needs it.

Dr. Angel Marquez — OB/GYN
Arte & Cera · Education is care

This newsletter is general education, not medical advice, and doesn't create a patient relationship. For guidance about your own health, talk to your clinician.