Navigating Breast Cancer Treatment With Added Support
- Former “Charlie’s Angels” star Cheryl Ladd, 75, revealed she survived an aggressive form of breast cancer, describing the hair loss she experienced during treatment as a “humbling experience” and crediting her husband’s unwavering support throughout her recovery.
- Breast cancer screening guidelines remain a subject of debate, with the American College of Physicians recommending routine screening begin at age 50 for average-risk women, while organizations including the U.S. Preventive Services Task Force and American College of Radiology support starting mammograms at age 40.
- Breast surgeon Dr. Sharon Rosenbaum Smith tells SurvivorNet that “mammograms are our gold standard” and recommends women with a first-degree relative diagnosed with breast cancer begin screening 10 years before their relative’s age at diagnosis.
- Family history and genetics shift screening earlier: women with a first‑degree relative begin imaging 10 years before that relative’s diagnosis, while those with BRCA or similar mutations start MRI‑based screening at 25.
- Risk calculators help identify women who need intensified screening: tools like the IBIS/Tyrer‑Cuzick model flag women with a 20%+ lifetime risk, prompting earlier MRI (often starting at 30); Dr. Rosenbaum Smith explains that “it gives you a risk score” that guides individualized screening plans.
“I was bald. It was a humbling experience, and yet I have a wonderful husband…he was there for me at every turn, and that makes a big difference,” Ladd described while speaking on a panel about her breast cancer experience.
Read MoreBetter Understanding Your Breast Cancer Risk
In April 2026, the American College of Physicians (ACP) reaffirmed its recommendation that average-risk women begin screening at 50 — a position that conflicts with most other major medical groups.
The U.S. Preventive Services Task Force lowered its own starting age to 40 in 2024, and the American College of Radiology pushed back strongly on the ACP’s guidance.
For Dr. Sharon Rosenbaum Smith, a breast surgeon at Northwell Lenox Hill Hospital in New York City, the message to patients hasn’t changed.
“Mammograms are our gold standard, and there have been some other suggestions of altering the imaging protocol,” Dr. Rosenbaum Smith tells SurvivorNet.
WATCH: Reducing Anxiety About False Positives
“But the American College of Surgeons, American College of Radiology, we all still stand by the existing guidelines, which is mammograms starting at the age of 40.”
A close relative’s diagnosis changes the timeline.
Dr. Rosenbaum Smith uses a simple rule: begin screening 10 years before the age at which your first-degree relative — a mother, sister, or daughter — was diagnosed.
“If you have a family history, we start imaging 10 years before a first-degree relative with breast cancer,” she says. “So, if your mother had breast cancer at 45, you are going to begin your imaging at the age of 35.”
Expert Resources for Breast Cancer Patients
- Exciting New Option For HR+, HER2- Breast Cancer Recurrence: With the Approval of Truqap, More Women Can Be Treated With Targeted Therapy
- Gedatolisib Approval Offers Hope for Many With Advanced HR+ Breast Cancer, But Means More Time in the Clinic for Patients
- For Triple-Negative Breast Cancer Patients Without Immunotherapy Options, FDA Approval of Datroway Brings Hope By Helping Patients Live Longer
- New Data And FDA Approval Brings Hope for Metastatic Triple-Negative Breast Cancer
- New FDA Approval Creates New Hope For 70% Of Advanced Breast Cancer Patients: The Drug Imlunestrant Turns Off Estrogen Effectively
Carrying a Breast Cancer Gene? Start at 25
Women who inherit a mutation in a breast cancer gene, such as BRCA1 or BRCA2, face a much higher lifetime risk and often develop cancer at younger ages. For them, screening starts far earlier.
“If you have a genetic predisposition to cancer, meaning you test positive for one of the breast cancer genes, then we recommend screening starting at the age of 25,” Dr. Rosenbaum Smith says.
For women in this group, early screening typically relies on breast MRI, with mammograms added in later years. Your doctor or a genetic counselor can map out the exact schedule for your specific mutation.
A Simple Online Tool Can Flag Higher Risk
Not every woman at elevated risk has a known gene mutation or a mother with breast cancer. To catch those cases, doctors use risk models that weigh several factors at once.
“Now, to add one more layer to it, there are certain risk models out there which we can use to calculate a person’s risk to say if they’re high risk or not,” Dr. Rosenbaum Smith explains. “The one that I typically use is something called the IBIS scale, otherwise known as the Tyrer-Cuzick Risk Calculator for Breast Cancer Risk Assessment.”
RELATED: Your Breast Density Is Not Static; The Way It Changes Over Time May Reveal Your Breast Cancer Risk
The calculator asks for a handful of details:
- Age
- Breast density
- Any previous breast biopsies
- Height and weight
- Use of hormone replacement therapy
- Family history of breast cancer
“It’s a very simple online program where you put in a couple of risk factors,” she says.
“When you put it into that, it gives you a risk score. If your risk is over 20, you are considered at a higher risk of breast cancer.”
That threshold refers to an estimated lifetime risk of 20% or more. Women who cross it qualify for more intensive screening, usually including annual breast MRI.
“And in those individuals, we are starting screening earlier than the age of 40,” Dr. Rosenbaum Smith says.
“So we generally will start MRIs at the age of 30 if you have an elevated [risk] BI-RADS score. So we have tools available to us to help individualize the treatment care for patients.”
The American College of Radiology recommends that every woman have a breast cancer risk assessment by age 25, so that those who need earlier or additional screening are identified in time.
RELATED: Mammograms Are Still the Best Tool for Detecting Breast Cancer — A Warning About Thermography
When to Screen for Breast Cancer
The medical community has a broad consensus that women should have annual mammograms between the ages of 45 and 54. However, an independent panel of experts called the U.S. Preventive Services Task Force (USPSTF) is saying that women should now start getting mammograms every other year at the age of 40, suggesting that this lowered age for breast cancer screening could save 19% more lives.
The American Cancer Society recommends getting a mammogram every other year for women 55 and older. However, women in this age group who want added reassurance can still get annual mammograms.
WATCH: When you’re getting a mammogram, ask about dense breasts.
Women with a strong family history of breast cancer, 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 the age of 30, are considered at higher risk for breast cancer.
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 of developing breast cancer, you should begin screening earlier.
Screening Options for Women with Dense Breasts
Women with dense breasts should get additional screening to supplement their mammograms. Dense breasts mean more fibroglandular tissue, and less fatty breast tissue exists.
The dense tissue has a “masking effect on how well we can perceive cancer and find cancer on mammograms,” Dr. Cindy Ly, Chief of Breast Imaging and Vice Chair of Clinical Research and Faculty Affairs at the Stony Brook Renaissance School of Medicine, told SurvivorNet.
Glandular tissue within dense breasts appears white on mammograms, which can help mask potential cancer. The “frosted glass” effect from the glandular tissue can thus mask cancerous areas, especially developing ones. Undetected, these cancers can progress, growing large and advanced. They will then likely require more intensive treatments to cure, or can become incurable altogether.
WATCH: What is 3D Mammography?
“Digital mammography, it turns out, significantly improves the quality of the mammogram…It’s 3D or tomosynthesis mammography,” Dr. Connie Lehman, a diagnostic radiologist who specializes in breast cancer at Massachusetts General Hospital in Boston, explains.
“This allows us to find more cancers and to significantly reduce our false-positive rate. With digital mammography 3D tomosynthesis, we’re taking thin slices through that breast tissue, like slices of a loaf of bread. We can look at each slice independently rather than trying to see through the entire thickness of the loaf of bread. So those thin slices help us find things that were hidden in all the multiple layers,” Dr. Lehman adds.
Additional testing can be considered for dense breasts, depending on a woman’s personal history, preferences, and physician’s guidance. These tests include:
- 3-D Mammogram (Breast Tomosynthesis): This technology acquires breast imaging from multiple angles and digitally combines them into a 3D representation of the breast tissue. This allows physicians to see breast tissue architecture better, even in dense breasts. 3D mammograms are fast becoming the standard way of performing mammography.
- Breast Magnetic Resonance Imaging (MRI): An MRI machine uses magnets to create highly detailed, intricate images of the breast. These are mostly reserved for women with an extremely high breast cancer risk. Dense breasts alone may not be a valid reason to obtain a breast MRI. However, dense breasts in women with genetic mutations, like BRCA1 and BRCA2, or a strong family history of breast cancer, could justify obtaining breast MRIs.
- Molecular Breast Imaging (MBI): MBI is a newer imaging technique that uses a radioactive tracer to detect breast cancer. It is beneficial for women with dense breasts. However, MBI is not as widely available as other screening methods.
The Food and Drug Administration (FDA) now requires facilities offering mammograms to notify patients about their breast tissue density and recommend they speak with a doctor to determine if further screening is necessary. There will be “uniform guidance” on what language to use and what details to share with the patient to make the communication clear and understandable.
Understanding Your Mammogram Report
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 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.
How Can I Manage Mammogram Anxiety?
It’s common to feel anxious while awaiting mammogram results. This feeling is often called mammogram anxiety.
If you are awaiting test results and your nerves are running rampant, try doing something that relaxes you, such as exercising or listening to your favorite music. Breathing exercises and meditation can also help you relax.
SurvivorNet has more resources to help you manage your mental health while awaiting test results.
Breast Cancer Symptoms & Self-Exams
Women are encouraged to do regular self-exams to become familiar with how their breasts feel normally, so when something unusual, like a lump, does form, it can be easily detected. A self-exam includes pressing your fingertips along your breast in a circular motion.
For some women, that means going to their doctor and walking through what a self-breast exam looks like, so they know what normal breast tissue feels like, so if they do feel something abnormal, whether it’s a lump or discharge from the nipple, they know what to ask and what to look for.
Below are common symptoms to look out for:
- New lump in the breast or underarm (armpit)
- Any change in the size or shape of the breast
- Swelling of all or part of the breast
- Skin dimpling or peeling
- Breast or nipple pain
- Nipple turning inward
- Redness or scaling of the breast or nipple skin
- Nipple discharge (not associated with breastfeeding)
Questions to ask your doctor
- With my family history, when should I start mammograms, and how often?
- Do I have dense breasts, and do I need extra imaging?
- Should I see a genetic counselor?
- If my parent is diagnosed, what support is available for caregivers?
Learn more about SurvivorNet's rigorous medical review process.
