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This makes intuitive sense: Absent any symptoms, I would have waited until I turned 40—possibly 45—before ever considering a mammogram. What I didn’t know until after my diagnosis is that I would have been behind schedule. I’ve since learned that the mammogram recommendations are more detailed than I realized—and that I’d missed a few potentially life-saving finer points.
Eric Winer, MD, the director of Yale Cancer Center and president and physician-in-chief of Smilow Cancer Hospital in New Haven, Connecticut, tells SELF that there’s not quite a consensus on when cis women and people assigned female at birth should begin getting mammograms. Though the US Preventive Services Task Force lowered the recommended age to 40 in a new set of guidelines released in May of last year, “There has been a back and forth between 40 and 50” across health authorities, Dr. Winer explains.
“A number of years ago, the American Cancer Society (ACS) took a very measured approach and set the age at 45 for average-risk women,” Dr. Winer says. “Now, it says that women have the option of starting at 40, but should begin obtaining annual mammograms no later than 45 and continue that approach for at least the next decade. At age 55, they have the option of switching to an every-other-year schedule.” This continues for as long as the patient is in good health and is expected to live at least another 10 years.
The key words here are “average-risk.” High-risk individuals have their own set of screening rules. “We recommend that a woman with a family history of breast cancer, which could include their mother, sister, aunt, or grandmother, consider starting mammograms 10 years prior to the age at which that person was diagnosed, or starting at 40—whichever comes first,” Michelle Specht, MD, the codirector of Avon Comprehensive Breast Evaluation Center at Massachusetts General Hospital and a faculty member at Harvard Medical School, tells SELF. “If a woman has a family member diagnosed with breast cancer at a very young age—under 40—then we use breast MRI to screen between the ages of 25 and 30,” she explains. “I worry that women are not aware of current screening guidelines.”
I wasn’t. Applying this rule to my own family history, I should have gotten annual mammograms starting at around age 34. Applying it to my family’s future, I’ll encourage my daughters to request MRIs beginning at age 26—10 years before my age at diagnosis—unless the recommendations change.
Dr. Specht notes that the majority of breast cancers discovered in women under 40, which represent 7% of all new cases, are found in people with genetic abnormalities or strong family histories of the illness. However, there are other risk factors that should trigger early screening, as the ACS advises. These include having had chest radiation before the age of 30, or living with health conditions including Li-Fraumeni syndrome and Cowden syndrome.
Having a lifetime breast cancer risk over 20%, as calculated by a Breast Cancer Risk Assessment Tool (BRCAT), also suggests you should begin screening early. Prior to my diagnosis, I had never undergone this type of risk assessment, but I’ve since learned that my own lifetime risk was 33%, well above the national average of 13% and above the threshold for early screening. The National Cancer Institute provides an online version of this tool, which you can try at home. By sharing your results with your doctor, you can begin an important conversation about your risk level and find out whether you’re a candidate for early screening.