Who should be screened for breast cancer?
Who should be screened?- Screening mammography is recommended for women beginning at age 40, even if you have no symptoms and feel healthy. Early detection through regular screening saves lives.
- If you are at average risk: Average-risk women should begin annual mammographic screening at age 40 and continue as long as they are in good health.
- If you are between ages 25 and 39: Women ages 25–39 usually do not need routine mammograms yet, but you should have a breast cancer risk assessment by age 25. This conversation with your doctor will review your family history, ancestry, and other factors to determine your personal risk level. You should also be familiar with how your breasts normally look and feel so you can notice any changes.
- If you are at higher risk: You may need to start screening before age 40 and may benefit from additional imaging, such as breast MRI. You may be at higher risk if you have a strong family history of breast cancer, a known genetic mutation (such as BRCA1 or BRCA2), a calculated lifetime risk of 20% or greater, prior radiation therapy to the chest between ages 10 and 30, or a personal history of breast cancer. Black women and women of Ashkenazi Jewish descent are encouraged to discuss their risk with a doctor by age 25, as they may face elevated risk at younger ages.
- If you notice any changes in your breast: Regardless of your age or when your last screening was, contact your doctor right away if you notice a new lump, skin changes, nipple discharge, persistent pain, or anything that looks or feels different from your normal. These changes do not always mean cancer, but they should always be evaluated promptly.
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What should I expect when undergoing breast cancer screening?
What should I expect?Routine screening is important because early-stage breast cancer is much easier to treat and has significantly better outcomes than breast cancer found at more advanced stages. If you’re unsure when to start or how often to be screened, talk with your doctor about your individual risk and preferences.
The most widely used screening test is a mammogram, which uses low-dose X-rays to create detailed images of breast tissue. Mammograms can detect small abnormalities, including tumors or calcifications, long before they can be felt during a physical exam. Many facilities now use 3D mammography (also called digital breast tomosynthesis), which captures images in thin slices and can improve detection, especially in dense breast tissue. During routine screening, images are typically taken from multiple angles to provide a comprehensive view of each breast.
In some cases, additional imaging may be recommended. For example, breast ultrasound may be used to further evaluate a specific area of concern or to supplement screening in individuals with dense breast tissue, where mammograms can be harder to interpret. Breast MRI may be recommended for people at higher risk, including those with a strong family history of breast cancer or known genetic mutations, as it can detect cancers that may not be visible on a mammogram alone. For some higher-risk individuals who cannot undergo MRI, contrast-enhanced mammography may be an option.
Being called back for additional imaging after a mammogram is common and does not necessarily mean something is wrong. Breast cancer screening is designed to be proactive. Staying consistent with your recommended screenings and following up promptly on any additional imaging helps ensure that any concerns are identified and addressed as early as possible.
How should I prepare for a mammogram?
How should I prepare?Preparation for a mammogram is simple. Avoid using deodorant or lotions under your arms or on your breasts on the day of the exam, as these can affect the imaging. Keep in mind that you will need to undress from the waist up when selecting what to wear to your appointment.
It’s also helpful to schedule your mammogram when your breasts are least tender, such as the week after your menstrual period.
What happens during a mammogram?
What happens during a mammogram?A mammogram typically takes about 15–20 minutes. During the exam, each breast is placed on a flat surface and gently compressed with a plate to spread out the tissue for more accurate images.
You may feel some pressure or brief discomfort for a few seconds during compression. The technologist will take images from different angles, and you can return to normal activities immediately afterward.
What happens after a mammogram?
What happens after a mammogram?Most people receive their mammogram results within a few days. Your results will fall into one of three categories:
- No signs of cancer: In this case, you’ll continue yearly routine screening.
- Abnormal result: This does not necessarily indicate that you have breast cancer. You may be called back for additional imaging, such as diagnostic mammography or ultrasound, to take a closer look at a particular area.
- If anything abnormal is found, your care team will guide you through the next steps, which may include further imaging, biopsy, or treatment as needed.
Breast Cancer Screening FAQs
Breast Cancer Screening FAQsAnnual screening detects cancers earlier and saves more lives than screening every other year, particularly for women in their 40s when breast cancers tend to grow faster. There is no recommended age to stop screening, you should continue for as long as you are in good health and would be willing to undergo treatment if cancer were found.
Dense breast tissue is common — nearly half of all women have it. Dense tissue can make it harder to detect cancer on a mammogram, and can slightly increase your risk of developing breast cancer.
Supplemental screening beyond your annual mammogram may be recommended for people with dense breasts. Options include breast MRI, ultrasound, or contrast-enhanced mammography. Your care team will help determine which approach is most appropriate based on your overall risk profile.
Mammograms can cause brief discomfort due to compression, but the procedure is quick and generally well-tolerated. Scheduling your exam when your breasts are less tender can help with discomfort.
Mammography is considered very safe, but like any medical test, there are a few things to be aware of:
- Radiation exposure: Mammograms use a very low dose of radiation, roughly equivalent to the amount of natural background radiation you receive over about seven weeks of everyday life. The risk from this exposure is extremely small, and for women 40 and older the benefits of detecting cancer early far outweigh it.
- False positives: Sometimes a mammogram identifies an area that looks abnormal but turns out not to be cancer after additional testing. This is more common in younger women, women with dense breasts, and those getting their first mammogram. While a callback can cause anxiety, it is a normal part of the screening process and in most cases leads to a benign finding.
- False negatives: No screening test is perfect. A small number of cancers may not be visible on a mammogram, particularly in dense breast tissue. This is one reason supplemental screening, such as MRI or ultrasound, may be recommended for certain patients.
- Discomfort: Breast compression during a mammogram can be uncomfortable, but it lasts only a few seconds per image. Compression is necessary to produce clear images and actually helps reduce the minimal radiation dose. If you've found mammograms painful in the past, talk to your technologist. Scheduling during the first two weeks of your menstrual cycle or taking an over-the-counter pain reliever beforehand can help.
Breast cancer may not cause symptoms in its early stages. Delaying screening means that you may miss catching breast cancer at its most treatable stage.
Most insurance plans, including Medicare, cover recommended screening mammograms for eligible individuals. Coverage for additional imaging may vary.
There is no set age at which you should automatically stop getting mammograms. The decision to continue should be based on your overall health rather than your age alone.
Breast cancer risk increases with age, and a significant number of breast cancers are diagnosed in women over 74. If you are in good health and would pursue treatment if cancer were found, continuing annual screening is generally recommended. Many doctors advise ongoing screening as long as your life expectancy is five years or more.
If you have other serious health conditions that significantly limit your life expectancy, the potential benefits of screening may be smaller and the decision becomes more personal. This is a conversation worth having with your doctor, who can help weigh the benefits of continued screening against your individual health picture.
This content has been reviewed by the following medical editors.