An expert panel has recommended mammograms starting at age 40. Doctors weigh in on risk and prevention tactics for this age group.
Last week, a panel of U.S. health experts issued a striking update to their guidance on breast cancer screening, urging women who are at average risk for the disease to start getting mammograms every other year starting at age 40, rather than age 50.
The new draft recommendation from the U.S. Preventive Services Task Force comes as rates of breast cancer are rising in younger women, said Dr. Wendy Chen, an oncologist at Dana-Farber Cancer Institute. Doctors aren’t entirely sure why those numbers are increasing. The task force also pointed to persistently high mortality rates for breast cancer among Black women in particular.
There is no surefire way to prevent breast cancer, oncologists said, and detection doesn’t always result in successful treatment. But finding and treating cancer earlier might save more lives, and adopting healthy behaviors now could reduce the risk of developing the disease in the future.
Why experts are emphasizing earlier screening
Screening can help detect breast cancer earlier — which can be particularly important for younger women because they tend to have more aggressive and faster-growing cancers than older women, said Dr. Sarah Friedewald, the chief of breast imaging at Northwestern Medicine.
Most women with breast cancer don’t have a family history of the disease, said Dr. Elizabeth Comen, a medical oncologist at Memorial Sloan Kettering Cancer Center. But a woman’s risk nearly doubles if she has a first-degree relative — meaning a mother, daughter or sister — who has had breast cancer. Certain other types of cancer are associated with a higher risk, as well: A family history of ovarian, pancreatic or prostate cancer may make you more likely to have a genetic mutation tied to breast cancer, Dr. Chen said. Women with dense breasts — meaning their breasts contain a larger amount of fibrous and glandular tissue, compared with fatty tissue — are also at an increased risk of developing breast cancer.
Ideally, you should discuss your breast cancer risk with your primary care doctor or OB-GYN around age 25, Dr. Friedewald said. If you haven’t had that conversation yet, it’s never too late. You can also use online tools like the Breast Cancer Surveillance Consortium Risk Calculator to help assess your risk.
When you turn 40 (or earlier, based on your risk level), your doctor will probably recommend you have a mammogram. If you have dense breasts, your doctor may advise getting additional imaging, like a breast ultrasound or magnetic resonance imaging.
Why earlier screening is still controversial
Doctors and researchers are divided on how helpful frequent and early screenings are for women with an average risk of breast cancer. Some doctors, and the American College of Radiology, encourage women to get screened once a year starting at 40, rather than every other year, to maximize the chances of detecting breast cancer at an early stage.
One reason for the debate over the timing and frequency of screenings is that the net benefits of screening are smaller in younger women compared to older women — that is, there is less of a chance of detecting cancer in younger women, but there are still harms associated with screening, like the psychological strain of follow-up imaging, said Dr. Jeffrey Tice, a breast health specialist at the University of California, San Francisco.
When a mammogram detects an abnormality, it may not be clear without a biopsy whether that finding is benign or malignant. Mammography also works less well in younger women because their breasts tend to be more dense, Dr. Tice said. There is also the possibility that screenings can detect very early cancers that may not progress to life-altering, or life-threatening, disease, said Dr. Laura Shepardson, head of the section of breast imaging at Cleveland Clinic; as a result, patients may undergo therapies that they potentially do not need.
The more often that women are screened, the more abnormalities that are found, Dr. Tice said. Some biopsies don’t indicate cancer, yet still create anxiety for patients — but many biopsies do find cancer, he said, which saves lives.
Dr. Shepardson said that the task force is advising mammograms every other year because it’s “saying that there’s a real risk of anxiety that’s undue, or of unnecessary biopsies.” But “the American College of Radiology doesn’t feel like that’s a risk or a harm. That’s being proactive,” she said.
How to reduce your overall risk
“You can do everything right and still, for reasons entirely out of one’s control, end up with cancer,” Dr. Comen said. Many of the factors that contribute to breast cancer risk, like genetics and a family history of cancer, aren’t modifiable; others are within a patient’s control, but not necessarily practical. For example, having a child before age 35 lowers the risk of breast cancer, as does breastfeeding, but a doctor would never recommend a woman have a child by a certain age to reduce cancer risk, said Avonne Connor, a cancer epidemiologist at Johns Hopkins Bloomberg School of Public Health.
But a few behaviors have been linked to a lower risk of breast cancer, doctors said.
Limit your alcohol consumption.
A mounting body of evidence has tied drinking to a higher risk of cancer in general — and potentially to breast cancer in particular, partly because alcohol can boost levels of estrogen in the body. That doesn’t mean you can never drink, but doctors urged caution: Dr. Comen recommended that women who want to reduce their breast cancer risk associated with alcohol have no more than three alcoholic drinks per week on average, and to be open and honest about their drinking habits with their doctors.
“Keep it at the lowest level that feels reasonable,” said Dr. Rachel Yung, a medical oncologist at Fred Hutchinson Cancer Center in Seattle.
Exercise regularly.
Physical activity may help reduce the risk of breast cancer and improve outcomes for people in treatment for high-risk breast cancer, said Karen E. Knudsen, chief executive of the American Cancer Society. That may be because working out reduces levels of estrogen, combats inflammation and strengthens your immune system. Aim for 150 minutes or more of moderate to vigorous physical activity per week, Dr. Knudsen said.
Eat more plant-based foods.
The Mediterranean diet has been linked to a lower incidence of breast cancer, Dr. Tice said, for reasons researchers aren’t entirely sure about. Experts recommend cutting back on red meat and incorporating more plant-based foods in your diet.
Consider breast self-exams.
Cancer researchers are divided on the utility of self-exams. There isn’t robust evidence suggesting that they improve survival rates, but doctors say that routinely assessing one’s breasts can help women spot early signs of cancer. Estimates vary from study to study, but about half of breast cancers are detected by patients, Dr. Tice said.
Dr. Comen recommended women pick one day per month — ideally not during a period if they menstruate — to check for lumps in the breasts, underarms or clavicle area. Women should also generally keep an eye out for other signs of disease, like nipple discharge, skin puckering, redness, flakiness or unexplained swelling, she said.
“I think that women should feel very comfortable knowing what their breasts feel like,” said Dr. Comen. “It’s an important way for women to be — literally — in touch with their bodies.”
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