By the time women turn 40, most use a seat belt every time they step into a car, probably without giving it much thought. The same should be true for their annual mammogram -- in each case, their lives are at stake.
Throughout my thirty years of working in the specialty of breast imaging, I have treated many patients who have had aggressive forms of breast cancer. One in particular attended her grandson’s wedding and, as she saw him walk down the aisle, realized that if her cancer hadn’t been discovered during a routine screening, she wouldn’t be alive for this momentous occasion.
In 2023, the U.S. Preventive Services Task Force updated its breast cancer screening recommendations, recommending all women start getting screened when they turn 40. Before this change, women were encouraged to start screening between the ages of 40 and 50, based on their own individual decision. But even this is not adequate. Now, breast specialists from the Society of Breast Imaging (SBI) and the American College of Radiology (ACR) recommend that women get screened annually starting at age 40.
Why 40? Breast cancer incidence increases substantially around 40, and continues to do so until 80. Annual screening starting at 40 results in the most lives saved and greatest mortality reduction. It increases the chance of catching breast cancer early, when it is easier to treat with more options. If a woman only receives a screening every two years, then a possible tumor has the opportunity to grow. If the tumor is detected at stage zero, there is a 99% cure rate. However, if a woman delays her screening until she feels a lump, then the tumor is already at a much later stage, and requires more difficult treatment. The idea is to find the tumor before the patient feels it, which can be accomplished effectively through annual screening mammograms.
Newer technologies, such as 3D mammograms, also known as breast tomosynthesis, can locate tiny tumors that a person would not feel, making them the best tool we have for detecting breast cancer early. For patients with dense breasts, they may also need additional help to find tumors, by using breast ultrasound and MRI techniques.
It all starts with staying informed. ACR recommends all women to speak with their doctor by age 25 to assess their breast cancer risks so that those at highest risk can be identified and benefit from supplemental screening. Black, Asian and Hispanic women account for one-third of breast cancer diagnoses in women under 50, and Ashkenazi Jewish women face an elevated risk as well. Risk factors also include a family history of breast cancer, genetic mutations or previous chest radiation.
Just like putting on your seatbelt, getting an annual mammogram at the appropriate time – age 40 for most women – has no downside and should be routine. Most people will not be in a life-threatening car accident, and most women will not get breast cancer. But one in every eight women will get breast cancer, and if you’re one of them, you want to find it as early as possible. Because 5% of women diagnosed with breast cancer have no risk factors, a mammogram is absolutely crucial.
I understand the fear and anxiety breast cancer can evoke. I’ve treated patients who were hesitant to get screened due to fear or other concerns. It’s important to remember that most women with breast cancer survive. Early detection saves lives.
Dr. Christina Giuliano is the vice chair of Breast Imaging, Education and Research at Maimonides Health.
