Published Feb 10, 2026

54-Year-Old Mom of Four Nearly Skips Mammogram—Husband’s Nudge Leads to Multicentric Breast Cancer Diagnosis

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The Importance of Breast Cancer Screenings

Mary Royal, a mother of four from Texas, was diagnosed with rare multicentric invasive lobular and ductal breast cancer in 2023 after nearly skipping her mammogram. After undergoing treatment, which included chemotherapy and radiation, she is now a survivor and raising awareness on the importance of mammograms.
The medical community has a broad consensus that women should have annual mammograms between the ages of 45 and 54. However, if you have a higher risk for breast cancer due to a family history or a genetic mutation, you should consider screening at age 40.
Women with dense breasts are at a higher risk of developing breast cancer because dense breast tissue can mask potential cancer during screening.
Enhanced mammography exists and includes: 3D mammograms, breast ultrasound, breast MRI, and molecular breast imaging, which 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. women with dense breasts for a more precise screening. It is important to ask your doctor about your breast density and cancer risk.

Mary Royal, a mother of four from Wichita Falls, Texas, was diagnosed with multicentric breast cancer—a rare form of the disease in which tumors develop in multiple areas of the breast—after her husband Jerry Royal urged her to go through with a mammogram she had almost canceled.

Royal, who works at a child advocacy center, shared her story with CURE Today in an effort to encourage others not to put off breast cancer screenings. She recounted being diagnosed in 2023, during a time she was a very”busy” working mom with two children in college, one in law school, and a teen in junior high.

She told CURE, “In July of 2023, I went in for a routine physical that I started going to when I was 50. My husband was like, ‘You have got to go to the doctor, besides the female doctor.’ I think in 2020 I started going, or 2021, every July. He had started me on, you need to have your colonoscopy, you haven’t had your mammogram in a bit — I had had mammograms my entire life, every year, especially during birthing years, and I did my gynecological exam that year.

“I went back in 2022, he had also scheduled me a mammogram and a colonoscopy. I made the colonoscopy, I canceled the mammogram because something came up, and I’d had them a million times, and you know, everything was fine.

Recounting how her husband noticed his wife hadn’t gotten a mammogram in 2023, he then pushed her saying, “You need to go.”

Royal, noting how she admitted to her husband that she needed to “knock this out,” then made an appointment for August 2023.

When the appointment day arrived, Royal was overwhelmed by family responsibilities—taking her son to Texas for his freshman year of college and traveling to Arkansas to see her daughter—and nearly called off her mammogram.

She explained, “I had that appointment on Monday afternoon, almost canceled again, but something inside was like, ‘Mary, you have neglected this.’ It was kind of a COVID neglect, I think, too.

“You know, I’m past having kids, everything is fine, but I was like, ‘No, I need to go.’ So literally, I drove in from Fayetteville into town, straight to my appointment. Did the appointment, no problem.”

The day after her appointment, Royal heard from her doctor that an additional ultrasound was required, but she wasn’t concerned because follow-up calls were something she had experienced before due to having dense breasts.

However, following the ultrasound, she was informed her doctor wanted to speak with her.

“I started to walk to his office, and I tell people that I knew in that moment I had breast cancer. I mean, it’s just one of those animated feelings of walking down the hallway like, ‘I don’t know what this is, but I think it is breast cancer,'” she recalled.

Her doctor, who she describes as a family friend then told her, “Mary, I think it’s going to be fine. They found four spots, and so I’m going to send you in the morning to a surgeon. I’m sure it’s going to be fine.”

Royal was ultimately diagnosed with multi-centric invasive lobular [cancer that starts in the milk-producing lobules of the breast] and ductal carcinoma [the cancer started in the milk ducts]. Since the cancer was invasive, it had spread beyond the lobules and ducts into surrounding breast tissue, in different areas of the breasts.

After undergoing a comprehensive treatment plan, which included chemotherapy and radiation, and a preventive hysterectomy, Royal is now a breast cancer survivor.

Thankfully, Royal attributes her peace of mind to the NeXT Personal Dx blood test, which detects earlier cancer recurrence, as it has consistently shown no detectable tumor DNA.

Mary Royal pictured with her husband and four children (YouTube/Personalis, Inc.)

Helpful Information About Breast Cancer Screening

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) 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.

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 with 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.

WATCH: 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.

Family History & Breast 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

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.

WATCH: Understanding genetic testing for breast 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 with a family history to get [genetic testing],” Dr. Ginsburg previously told SurvivorNet. “I would say that if you have anyone in your family diagnosed with a 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.

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.

“Digital mammography, it turns out, significantly improves the quality of the mammogram… It’s 3D or tomosynthesis mammography,” Dr. Connie Lehman, the chief of the Breast Imaging Division at Massachusetts General Hospital, told SurvivorNet in an earlier interview.

“This allows us to find more cancers and 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 entire 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 her physician’s guidance.

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.

WATCH: 3D Mammograms explained.

Additional testing includes:

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.

A new rule from the Food and Drug Administration (FDA) says that facilities offering mammograms must notify patients about their breast tissue density and recommend that 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.

Breast Density Doesn’t Remain the Same Over Time, Impacting Your Cancer Risk

Women with dense breasts are at a higher risk of developing breast cancer. This connection has been demonstrated time and again in several rigorous scientific studies. 1 in 6 women with dense breasts is at risk for breast cancer. Comparatively, 1 in 8 women with average breasts are at risk for this cancer. The exact reason for this difference is not fully understood.

Researchers from Washington University School of Medicine in St. Louis and Brigham and Women’s Hospital in Boston analyzed this connection in a new study.

They recruited 947 women between November 2008 and October 2020. All women were cancer-free at the start of the study and received yearly or biyearly screening mammograms. Researchers tracked the women’s mammogram reports and breast densities over time.

All women experienced a decline in their breast density during the 12 years. Two hundred eighty-nine women developed breast cancer during this time. Those who developed cancer had a lower rate of decrease in breast density than those who did not. The researchers concluded that the rate of breast density changes may indicate future breast cancer risk.

WATCH: Mammograms are still the best tool for detecting breast cancer.

Regular Self-Exams Are Helpful In Between Mammograms

A self-breast exam is an easy way to monitor your breasts for abnormalities. It involves feeling the breast for swelling, bulging, or changes in the shape of the breast or nipple.

WATCH: How to perform a self-exam.

Checking for signs of redness, rashes, or discharge is also part of this exam. If anything is found that is concerning, you should contact your doctor. It’s important to note that self-exams should be done with regular mammograms.

How AI Is Enhancing Mammograms When Screening For Breast Cancer

The artificial intelligence program that has received approval from the Food and Drug Administration (FDA), called Clairity Breast, may change the way doctors assess breast cancer risk from screening mammograms.

While not a replacement for traditional mammography, this AI-powered tool can enhance current screening practices and improve early detection efforts, according to Dr. Mary Newell, a breast imaging specialist at Winship Cancer Institute of Emory University.

“This new approach can enhance the current standard of care,” Dr. Newell tells SurvivorNet.

Clairity Breast analyzes subtle patterns in screening mammograms linked to future breast cancer risk, generating a validated five-year risk score. This score is seamlessly integrated into clinical systems, enabling more personalized follow-up care.

“We can identify patients who are at elevated risk and offer supplemental screening to them with breast MRI or other technologies as a way to increase the likelihood of early detection. It does not replace mammography, and in fact, relies on mammographic images to allow the risk assessment,” she adds.

How to do a self-breast exam.

Currently, women at average risk are advised to begin yearly mammograms at age 40. While Clairity Breast does not change these guidelines, Dr. Newell noted that it could help identify patients who may need earlier screening or additional imaging methods.

“It may allow us to identify patients who should start screening at an earlier age if they are shown to be at elevated risk,” she said. “It can also allow us to identify patients who may benefit from supplemental screening technologies, in addition to their yearly mammogram, after the age of 40.”

Unlike AI programs designed to detect cancer directly from images, Clairity Breast functions as a risk assessment tool. It does not interpret mammograms for cancer detection but instead works alongside traditional methods to pinpoint patients who may be at higher risk.

“Other AI tools are being developed that provide assistance with interpretation, helping to detect a cancer that may already be present,” Dr. Newell explained. “But most of the literature to date suggests that AI tools work best when deployed in conjunction with interpretation by a breast radiologist.”

Clairity Breast represents a promising step in breast cancer prevention, offering a new layer of analysis that helps doctors identify high-risk patients early and refine screening approaches — all while keeping mammography at the core of detection.

How is 3D mammography different?

“Now, advancements in AI and computer vision can uncover hidden clues in mammograms — invisible to the human eye — to help predict future risk,” said Dr. Lehman, founder of Clairity and breast imaging specialist at Mass General Brigham, in a press release.

Dr. Amani Jambhekar, a board-certified surgeon specializing in breast cancer and melanoma at CHRISTUS Health, says this new technology can make mammograms even more valuable.

“It may be a more individualized way of calculating breast cancer risk, which we need, as existing risk calculators do not identify everyone who is high risk. As a surgical oncologist, I am excited to learn more about this platform when it launches,” Dr. Jambhekar tells SurvivorNet.

RELATED: When Should I Get a Mammogram?

False Positives & the Dreaded ‘Callback’

If you went in for your mammogram and received a call from the doctor’s office to say more images, including MRI or ultrasound, may be required if the initial pictures aren’t clear, while worrisome, this scenario could mean a number of things. For instance, dense breasts, which we discuss elsewhere in this section, can make it hard to distinguish between fatty tissue and a tumor.

Here is how the numbers on screenings break down, according to Dr. Lehman: Of the approximately 10 percent of women who get called back, the vast majority will be absolutely fine after more imaging. Only 20 percent of those will need a biopsy, and in the end, just five percent of that group will be found to have cancer.

Here are some tips to help ensure you get the most accurate test possible:

Go to a large and experienced center that has a good record and reputation.
Don’t wear deodorant on the day of your mammography. It can contribute to inaccuracies.
Keep in mind that certain factors, like dense breasts, tattoos, and breast implants, may also result in errors.