Photo: Juice Images / Getty Images
If you're a Gen-Zer or a Millennial, mammograms may seem like a thing of the distant future. After all, both the American College of Obstetricians and Gynecologists (ACOG) and the American Cancer Society don't recommend screenings until age 40.
But, like all things in health, every person is different—and your breast cancer screening recommendations may differ too. (It's rare—the Cleveland Clinic reports that only five percent of all breast cancers occur in women under age 40—but it is possible to get breast cancer when you're young.)
"It can be confusing because some associations and organizations recommend different things," says Rachel Brem, M.D., founder and chief medical officer of the Brem Foundation, a nonprofit dedicated to breast cancer education and testing. "What they all agree on is that if you do get your mammogram annually starting at the age of 40 (or earlier if you have one of the risk factors discussed below), you have the greatest chance of survival."
So how do you know if you should get screened earlier? Here, experts break down your risk.
The General Guidelines
The latest update to the ACOG guidelines (announced in 2017) broadly recommends that women with an average breast cancer risk should consider mammograms starting at age 40—with every woman getting screened no later than age 50. After an initial screening, women (again, of average risk) should be screened every one or two years, per their doctor's recommendations. (Read: 6 Women Share Their First Mammogram Stories)
"We recommend getting a screening mammogram every year as part of your breast wellness self-care," says Stephen Rose, M.D., director of clinical research at Solis Mammography. "Annual screenings are most likely to find any breast cancer early, when it's tiny." It's recommended that most women continue until they're at least 75 years old. (Good news, though: This new technology is making mammograms less painful—because they really shouldn't be so bad.)
When You Should Start Early
Even if everything seems A-OK with your girls, there's a chance you may need to get screened earlier. "If you're 'high risk,' then it's encouraged that these yearly exams start at 30," says Robert Segal, M.D., cofounder of LabFinder.com, an online platform for scheduling and reviewing results from medical tests. "If you're concerned about your risk, the first step is to consult your doctor about earlier screening."
High risk, in this case, means you may:
- Have dense breasts. Having dense breasts increases your breast cancer risk by 25 percent, says Dr. Brem. (Here's everything you need to know about dense breasts and what it means for your breast cancer risk.)
- Have a family history of breast cancer. Pay attention if you have a first-degree relative (sibling, parent, or child) with breast cancer, especially if it is pre-menopausal breast cancer; more than one first-degree relative with breast cancer; a relative who had breast cancer in both breasts; or several second-degree relatives with breast cancer, says Dr. Brem.
- Have the "breast cancer gene." If you or one of your first-degree relatives have the BRCA1 or BRCA2 gene mutation (which you can determine based on genetic testing), your doctor will likely recommend you get screened early. (Note: Men can carry the BRCA gene as often as women, says Dr. Brem.)
- Have had radiation exposure. If your chest has been exposed to radiation (such as radiation therapy) between the ages 10 and 30, you may need to get screened early.
- Are an African-American woman. The American College of Radiology recently issued recommendations that African-American women start screening at an earlier age; specifically, that they have a risk assessment at age 30 to see if earlier screening is needed.
- Are Ashkenazi Jewish. Ashkenazi Jewish women have a much higher risk of breast cancer, says Dr. Brem. "In the general population, the risk of having a gene that increases the risk of breast cancer is one in 400. In the Ashkenazi Jewish population, it is one in 40," she says.
"If you have a family history of breast cancer, you should begin screening five to 10 years earlier than the age that your first-degree relative developed breast cancer," says Dr. Brem. Additionally, if you've had breast cancer or have had a biopsy that showed 'atypical' cells, which are not completely normal (but not cancer), you have a greater risk and should get screened earlier and often."
That doesn't always just mean mammograms: Ultrasounds, magnetic resonance imaging (MRI), and molecular breast imaging (MBI) are all being used in breast cancer screening.
When You Should Get Screened ASAP
Some doctors are saying traditional self-exam recommendations—you know, the "check yourself in the shower with two fingers and circular motions" thing—aren't that effective. (See: Doctors Break Down Your Breast Cancer Risk) The emphasis now is on knowing what's normal for your breasts.
Still, many doctors continue to recommend self-examinations: "Women should still perform breast self-examination every month, because no one knows a woman as well as she knows herself," says Dr. Brem. "If you feel that something has changed—dimpling of the skin of the breast or the nipple, bloody or new nipple discharge, any mass or any redness on her skin or nipple—you should see a health care provider." (Also get to know these 15 everyday things that can affect your breasts.)
In the end, "there is no cost, no radiation—truly, no downside—to self-examination, with the definite possibility of finding an earlier breast cancer," says Dr. Brem. So it's worth getting to know your breasts whether or not you have an increased risk.