When To Start Screening For Breast Cancer
- Sarah Ferguson, the 65-year-old Duchess of York and British author, underwent a single mastectomy (the removal of her breast) after being diagnosed with early-stage breast cancer last year. Now, she’s admitting that a routine mammogram that she “almost missed” saved her life.
- A mammogram is a standard breast cancer screening that examines breast tissue for signs of cancer.
- While there is some disagreement about the exact age a woman should start getting mammograms, doctors generally agree it should happen in their 40s. The American Cancer Society (ACS) suggests women should begin annual mammogram screenings for breast cancer at age 45 if they are at average risk for breast cancer.
- However, an independent panel of experts called the U.S. Preventive Services Task Force (USPSTF) says that women should start getting mammograms every other year at the age of 40, suggesting that this lowered the age for breast cancer screening could save 19% more lives.
Ferguson, who is mom to 36-year-old Princess Beatrice and 34-year-old Princess Eugene, and also a grandmother of four, underwent a single mastectomy (removal of her breast) after being diagnosed last year.
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“I’m reconciled to the fact that I’ll need to have checks for the rest of my life, but thanks to my mammogram and the treatment I underwent, my prognosis is good.”
Expert Resources on Breast Cancer Screening
- When You’re Getting a Mammogram, Ask About Dense Breasts
- Breast Cancer: Introduction to Prevention & Screening
- The Mammogram Debate: Should Women Start Breast Cancer Screening at 30?
- Women Should Now Start Getting Mammograms at 40, Expert Panel Suggests: The Benefits and Potential Risks of Earlier Breast Cancer Screening
- Earlier Mammograms for Black Women May Reduce Breast Cancer Mortality Disparity Rates By 57%; How to Screen for this Disease
- Mammograms Are Still the Best Tool for Detecting Breast Cancer — A Warning About Thermography
She added, “When you’re told you have cancer, you can’t help thinking it’s a death sentence. But there is help, treatment and support out there and in my case fortunately that doesn’t look like coming true.
“I have urged both Beatrice and Eugenie to be breast aware as breast cancer can strike at any age. It’s vital that we all take responsibility for our own health and if you think something’s wrong, ask for help and don’t take no for an answer.”
Ferguson also described cancer as “like a bomb going off in your life” which affects “your entire family.”
“I’m generally a positive person but getting not one but two cancer diagnoses in the space of a few months was a lot to deal with,” she continued.
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Ferguson first shared her cancer story on her podcast “Tea Talks with the Duchess and Sarah” in July 2023.
Sharing a clip from her podcast episode, the Duchess wrote in an Instagram post, “I am recuperating at the moment but keen to share my story here on my podcast, in the hope it encourages everyone who can to get screened.
“Thank you doesn’t quite cover it to all of my doctors, nurses and medical professionals. I’m beyond lucky to have you. I encourage everyone to get checked.”
Recounting how her daughters reacted to her cancer diagnosis, Ferguson said, “I think it’s scary for any family member out there, you really start to look at your own demise.
“It’s a wake-up call, and you think, how am I going to deal with this?”
Ferguson admitted that the reason why she’s doing the podcast today is to show others, “It’s not ok, but if you’re going to get it. Do the screening, catch it quick, and say, ‘I can do this.’”
“It’s not bravery, it’s not courage. It’s about understanding that you’re not going to feel as you did for a bit. So don’t try and be a superhero. Take many steps. Have the cup of tea. Trust people. Very important not to be complacent with every single thing now.”
What to Know About Screening For Breast Cancer
The medical community has a consensus that women between 45 and 54 have annual mammograms. However, an independent panel of experts called the U.S. Preventive Services Task Force (USPSTF) is saying that women should start getting mammograms every other year at the age of 40, suggesting that this lowered the age for breast cancer screening could save 19% more lives.
WATCH: Screening for Breast Cancer
For women aged 55 and older, the American Cancer Society recommends getting a mammogram every other year. However, women in this age group who want added reassurance can still get annual mammograms.
Women who have a strong family history of breast cancer, have dense breasts, have a genetic mutation known to increase the risk of breast cancer, such as a BRCA gene mutation, or a medical history, including chest radiation therapy before age 30, are considered at higher risk for breast cancer.
Understanding the BRCA Gene Mutation
Experiencing menstruation at an early age (before 12) or having dense breasts can also put you into a high-risk category. If you are at a higher risk for developing breast cancer, you should begin screening earlier.
Breast density is determined through mammograms. However, women with dense breasts are at a higher risk for developing breast cancer because dense breast tissue can mask potential cancer during screening. 3D mammograms, breast ultrasound, breast MRI, and molecular breast imaging are options for women with dense breasts for a more precise screening. It is important to ask your doctor about your breast density and cancer risk.
Although breast cancer can happen to anyone, certain factors can increase a person’s risk of getting the disease. The known risk factors for breast cancer include:
- Older age
- Having a gene mutation such as the BRCA1 or BRCA2
- Added exposure to estrogen
- Having children after the age of 30
- Exposure to radiation early in life
- Family history of the disease
RELATED: Is Genetic Testing Right for You?
Different types of genetic testing can help people with a family history of cancer better ascertain their cancer risks. Your doctor will discuss your family history of cancer with you in the context of your type of tumor and your age at diagnosis. Hereditary genetic testing is usually done with a blood or saliva test.
The second test involves the genetic sequencing of your tumor if you’ve been diagnosed with cancer by this point. These genetic changes can be inherited, but most arise during a person’s lifetime. This process usually involves examining a biopsy or surgical specimen of your tumor. This testing can lead to decisions on drugs that might work against your cancer
About ten percent of breast cancers are hereditary, says Dr. Ophira Ginsburg, Director of the High-Risk Cancer Program at NYU Langone’s Perlmutter Cancer Center.
“We encourage only those who have a family history to really get [genetic testing],” Dr. Ginsburg previously told SurvivorNet.
“I would say that if you have anyone in your family who was diagnosed with a very rare cancer. Or if you have a strong family history of one or two kinds of cancer, particularly breast and ovarian, but also colon, rectal, uterine, and ovarian cancer, that goes together in another cancer syndrome called the Lynch Syndrome,” Dr. Ginsburg adds.
The Unique Features of Breast Cancer
Getting Called Back After a Mammogram
Mammograms are a standard screening procedure for breast cancer. When you receive your regularly scheduled mammogram coupled with checking your breast with self-breast exams regularly, your chances of detecting the onset of breast cancer increase significantly. A self-exam includes pressing your fingertips along your breast in a circular motion.
If you’ve undergone a mammogram and, instead of receiving an all-clear, you get a call asking for you to return for further evaluation, that may be a frightening scenario.
When You’re Called Back After a Mammogram: Breaking Down the Numbers
However, it doesn’t need to be scary. More images, including MRI or ultrasound, may be required if the initial pictures aren’t clear. For instance, dense breasts can make it hard to distinguish between fatty tissue and a tumor.
Prior to letting fear or panic take over, remember not to jump to any conclusions. A callback could mean a number of things, but usually, it just means that your doctor wants to investigate something further, to rule out anything serious.
Here are how the numbers on screenings break down, according to Dr. Connie Lehman, Chief of the Breast Imaging Clinic at Mass General Hospital in Boston, who previously spoke with SurvivorNet.
Of the approximately 10 percent of women who get called back, the vast majority will be absolutely fine after more imaging.
Only 20% of those will need a biopsy, and in the end, just 5 percent of that group will be found to have cancer.
Survivors Encourage Women to Ask Their Doctors About Dense Breasts
Still, a period of waiting to hear more about something that could or could not be out of the ordinary is never easy.
Dr. Lehman says the goal is to resolve any uncertainties as quickly as possible. In the meantime, fill your time with healthy distractions until you receive the answers you’re looking for. And rest assured that it most likely means nothing at all.
She also advises that when you begin mammograms is a decision you should discuss with your doctor, as they can help you understand your specific circumstances and weigh the benefits and potential risks of earlier screening.
On the other hand, Dr. Lehman says, you should start yearly mammogram screening as early as age 30 if you fit into the high-risk category, meaning you have a first-degree relative who has had breast cancer, have the BRCA1 or BRCA2 gene mutation, or had radiation to the chest area when you were young.
If you’re older than 55, you can choose to continue your annual mammograms or opt to have one every two years, she says. If you’re post-menopausal, Dr. Lehman says you may be able to reduce the frequency of your mammograms to every other year.
Again, this is your choice and should be carefully considered with your doctor. Our medical reviewers inform us that mammograms are needed regardless of your family history due to most women with breast cancer having no family history or other identifiable risk factors.
Getting mammograms regularly at the recommended intervals can help spot early signs of anything that may be potentially harmful. This way, you and your doctor can address them right away.
Understanding Your Mammogram Report and Breast Density
A radiologist reading mammograms categorizes breasts into four different categories using the Breast Imaging Reporting and Data System (BI-RADS), a classification system developed by the American College of Radiology (ACR). These include:
- Fatty breast tissue: These breasts are mainly composed of fat with very little dense tissue. Found in less than 10% of women, fatty breasts appear dark on mammograms.
- Scattered fibroglandular breast tissue: These breasts contain a mix of fatty and dense tissue (composed of glands and fibrous tissue). On a mammogram, they have dark areas (fatty tissue) intermixed with light areas (dense tissue). Around 40% of women have breasts that fall in this category.
- Heterogeneously dense breast tissue: This type of breast tissue has many areas of dense tissue and some areas of fat. Found in 40% of women, these breasts look mostly light, with some dark areas on a mammogram.
- Extremely dense breast tissue: Such breasts are almost entirely composed of dense glandular and fibrous connective tissues with very little fat. They are found in 10% of women and appear light on mammograms.
Your breasts are usually called dense on a mammogram report if they fall within the heterogeneously dense breast tissue or the extremely dense breast tissue categories.
Resources for Cancer-Fighting Parents Trying To Support Their Kids
There are many resources to look to if you’re a parent with cancer who’s trying to figure out how to navigate the relationship with your children while you fight cancer, including specific pages on the American Cancer Society and MD Anderson Cancer Center websites.
“Children tend to think in very concrete terms and like to know what’s going on and what to expect,” a MD Anderson Cancer Center article reads.
“If they ask something that you don’t know the answer to, it’s okay to tell them that you don’t know and that you will work on finding the answer. The most important thing is to communicate openly, honestly and frequently.”
MORE: Telling Your Kids You Have Cancer ‘When it Comes to Your Kids, You Want to Protect Them’
Licensed clinical psychologist Dr. Marianna Strongin encourages people with sick parents “to talk about your feelings with your immediate family as well as your parents.” She’s previously talked about the importance of expressing your feelings in her advice column for SurvivorNet.
“Talking about difficult things does not cause more anxiety,” Dr. Strongin said.
“It is NOT talking about the very thing that we are all afraid or worried about that causes our body to feel dysregulated (unable to manage emotional responses or keep them within an acceptable range of typical emotional reactions) and anxious.”
Contributing: SurvivorNet Staff
Learn more about SurvivorNet's rigorous medical review process.
