When should you start having mammograms to screen for breast cancer, and how often should you have them? Ask 10 doctors this question and you might get 30 different answers. Ask a few trusted friends or relatives about their mammography schedules, and you’ll likely hear a lot of variety in their responses, too.
Why so much variation? Scientific understanding of the risks and benefits of breast cancer is still evolving and as a result, recommendations differ between experts. This has left many patients confused about their screening options.
At One Medical, we believe the decision to start screening is a personal one, that should be made based on one’s own values and unique health needs. As the harms and benefits of mammograms vary with age, race, genetics and health history, understanding your risk level and screening options is crucial to protecting your health. Below is our guide to how you can identify breast cancer and work with your primary care provider to determine the right time to start screening.
What is breast cancer?
Breast cancer occurs when uncontrollable, malignant cell growth takes place in the breast, creating a tumor. There are many types of breast cancers, categorized by the cells in which the cancer began. Most breast cancers begin in the lobules, the glands where milk is produced, or the ducts, the tubes that carry milk to the nipple. Some cancers may develop in the fatty, connective tissue within the breast. These cancerous cells can enter the bloodstream and lymph nodes and travel to other parts of the body. This is what is known as metastatic breast cancer.
What are the symptoms of breast cancer?
Breast cancers can present differently from person to person. Some people with breast cancer may not experience any symptoms at all, which is why screening is crucial in identifying and treating breast cancer. The most common symptoms include the following:
- New lump or tissue thickening in the breast or armpit
- Thickening or swelling of part of the breast (even if no lump is felt)
- Changes to the skin over the breast, such as dimpling
- Breast or nipple pain
- Redness or flaky skin on the nipple or breast
- Nipple retraction
- Nipple discharge other than breast milk, including blood
- Change in the size, shape, or appearance of the breast
- Rash around the nipple
It’s important to note that these symptoms can also be caused by things other than cancer. For instance, a lump in your breast could be the result of a benign cyst. If you are experiencing any of these symptoms or are concerned you may have breast cancer, you should reach out to your primary care provider. They will be able to help you rule out any other potential causes, as well as run the appropriate diagnostic tests.
Who is at risk of breast cancer?
While everyone with breasts is at risk of breast cancer, some individuals are more likely to develop the disease than others. Unique risk factors that may increase your chances of developing breast cancer include the following:
- Being born female: While those with male reproductive organs can get breast cancer, the disease is far more common in those with female reproductive organs. This includes cisgender woman, transgender men, and nonbinary individuals who were assigned female at birth.
- Age: Risk of breast cancer increases with older age and most breast cancers are diagnosed in those 55 and older.
- Genetic factors: According to the American Cancer Society, about 5 to 10% of breast cancer cases are thought to be hereditary. The most common cause of hereditary breast cancer in an inherited mutation in the BRCA1 and BRCA2 genes. Individuals with either of these mutations have a 7 to 10% chance of getting breast cancer by age 80, are more likely to be diagnosed with breast cancer at a younger age, and have a higher risk of having cancer in both breasts.
- Family history: You may be at higher risk of breast cancer if a first-degree relative (parent, child or sibling)) has been diagnosed with breast or ovarian cancer. The risk increases if multiple relatives have either of these cancers.
- Race: African American individuals are more likely to get breast cancer at a younger age. They are also more likely to die from breast cancer at any age. Asian, Hispanic, and Native Americans individuals have a lower risk of breast cancer.
- Breast density: Breast density refers to the amount of fibrous and glandular tissue visible on a mammogram. Those who have more connective tissue than fatty tissue have a higher breast density. Individuals with dense breasts have a slightly higher risk of breast cancer.
How do you screen for breast cancer?
The goal of breast cancer screening is to detect cancer before it causes symptoms. The most common way to screen for breast cancer is through a mammogram, which is an x-ray of the breast. Mammograms can detect tumors that may be too small to feel and can identify changes in breast tissue before physical symptoms develop.
Those who have a very high risk of breast cancer may also have a breast MRI in addition to their mammogram. MRIs use magnets and radio waves to take pictures of the breast. As MRIs can often come back abnormal even when there is no cancer, they are only recommended for those who have a very high risk of breast cancer after discussing the risks and benefits with their provider. Likewise, MRIs should only be used in addition to mammograms, not as a substitute, as they can also miss cancers a mammogram could detect.
When should I start screening?
At One Medical, we regularly review medical literature and guidance from respected public health organizations in order to inform our approach to breast cancer screening. In line with current United States Preventatives Services Task Force guidelines, we recommend that individuals with an average risk of developing breast cancer should have a screening mammogram every two years, starting at age 50 and stopping by age 75.
While in the past, screening was recommended annually starting at 40 years old, the USPSTF published updated guidelines in 2009, raising the starting age to 50 and decreasing the frequency to every other year. This decision was made based on a growing body of evidence suggesting that the harms of screening individuals before 50 outweighed the benefits. While screening can help detect breast tumors in their early stages, for instance, mammograms can often lead to “overdiagnosis” of abnormalities or cancers that will never cause any illness or death. As a result, some individuals end up receiving unnecessary radiation or treatment for a condition that otherwise would have never caused any symptoms or harm. Mammograms also tend to give “false positive” results, causing people to undergo additional testing and even biopsies, only to discover that they never had cancer. Along the way, they might endure needless radiation, disfigurement, surgical infections, and, as shown in a recent study, significant anxiety that persists for many years.
Taking all this information and much more into account, the USPSTF concluded that starting screening at age 50 and increasing the interval between mammograms from one year to two years has virtually no effect on the detection of clinically important breast cancers, but dramatically decreases the risk of subjecting people to incorrect diagnoses and unnecessary treatments.
That said, we believe the decision to start screening should be tailored to you and your individual needs. We encourage individuals 40 to 49 years old to discuss when to start screening and how often with their provider. Those who are at higher-risk of breast cancer may benefit from earlier or more frequent screening, so it’s important to weigh the potential benefits and harms of screening, as well as your personal and family health history, with the guidance of your primary care provider. Your primary care provider can help you assess your individual risk for breast cancer, discuss the pros and cons of different screening approaches, and help determine the best strategy for you.
While the thought of breast cancer may be scary or overwhelming, it’s important to remember that you are not alone. Your primary care provider is there to guide you, answer any questions you may have, and support you through any necessary treatment or follow-up care. At One Medical, we will work with you to develop a care plan based on your unique health needs and goals. Schedule a visit with one of our primary care providers today if you think you are at risk for breast cancer or have any other questions about your health.
The One Medical blog is published by One Medical, an innovative primary care practice with offices in Boston, Chicago, Los Angeles, New York, Phoenix, Portland, the San Francisco Bay Area, Seattle, and Washington, DC.
Any general advice posted on our blog, website, or app is for informational purposes only and is not intended to replace or substitute for any medical or other advice. The One Medical Group entities and 1Life Healthcare, Inc. make no representations or warranties and expressly disclaim any and all liability concerning any treatment, action by, or effect on any person following the general information offered or provided within or through the blog, website, or app. If you have specific concerns or a situation arises in which you require medical advice, you should consult with an appropriately trained and qualified medical services provider.