The ongoing debate was addressed concerning the appropriateness of mammographic screening for women aged 40-49 years, with particular emphasis on those patients with benign-appearing mammographic abnormalities (BMA), and whether findings differed from those of successive age decades. A review was conducted of 2,482 patients presenting for surgical consultation with a mammographic abnormality as a chief complaint, with particular emphasis on the 1,632 patients with BMA and more specifically those aged 40-49 years. Surgical interventions and risk factors for breast cancer were evaluated. Although 16% of 393 patients with BMAs biopsied were proven to have breast cancer, only 2.7% of all patients with BMAs were found to have breast cancer as a result of biopsy or short-term follow-up. Women aged 40-49 years represented 48% of patients with BMAs, and only 1.5% of these patients had breast cancer. The finding of breast cancer in the BMA population was progressive by decade of age, as would be expected, and in a cut-point analysis of those biopsied, age 60 best divided patients into high- and low-risk groups. Women aged 40-49 years with BMAs should not be excluded from mammographic screening, as they represented part of a continuum when successive decades were compared. Efforts should be directed at minimizing patient and physician anxieties as well as diagnostic interventions related to a BMAs.