Breast cancer ranks as the number one cancer among Indian women. According to statistics, for every 2 women newly diagnosed with breast cancer, one woman dies of it in India. This is a serious concern, considering the rising number of cases of breast cancer in our society, especially in the younger population. Cancer cases, as well as mortality, are increasing rapidly among Indian women especially due to late detection. It is a well- known fact that early detection decreases mortality for women with breast cancer. Breast cancer when found early is easier to treat successfully. Regular high-quality screening mammograms and clinical breast examinations are the most sensitive and reliable ways to screen for breast cancer.
Most young women who read about breast cancer or have seen a loved one affected with the disease often ask me ‘At what age should I get my first my screening mammogram?’. In this article, I am going to discuss the recommendations established by the American College of Radiology (ACR) and address a few common concerns women have regarding how and when they should start undergoing screening breast cancer. The ACR currently recommends women with an ‘average risk’ for breast cancer to undergo annual /yearly screening mammograms beginning at age 40.
What does this phrase ‘average risk’ mean and how does one know whether one is at a higher risk? In order to understand this, we must first address the issue of risk-assessment which essentially means identifying who is at risk and to what degree. Based on one’s risk, physicians recommend when and how you must be screened for breast cancer.
We are all aware that there are several factors that increase a woman’s risk for breast cancer. In nearly 5-10% of patients, there is a known genetic predisposition to breast cancer (commonly with BRCA 1 or BRCA 2 mutations). In these women, the lifetime risk for breast cancer is much higher (50-85% among BRCA 1 carriers and approximately 45% among BRCA2 carriers) compared to a 12% lifetime risk for a woman with ‘average risk’.
Even in the absence of known genetic mutations, women with strong family histories are at a higher risk. The number of family members diagnosed with breast cancer and their age at diagnosis are important while assessing risk. These factors determine when you should start screening. For example, if you are a known carrier of the BRCA gene mutation or are the untested relative of a known carrier, you must consider starting screening at age 25-30. If you have a first-degree relative (mother, sister, daughter) diagnosed with breast cancer before menopause, begin screening at age 25-30 or 10 years earlier than the age of diagnosis of your relative. For instance, if your mother was diagnosed with breast cancer at age 45, you should start screening mammography at age 35.
Women who have had a personal history of breast cancer are at risk for a recurrence or even another breast cancer. Also, their age at diagnosis matters. In fact, women diagnosed at or before age 50 and treated with breast conserving therapy also have a 20% or higher lifetime risk of a new breast cancer.
Often women undergo biopsies for suspicious findings on their yearly mammograms. If the biopsy results show high-risk changes such as Lobular neoplasia, these women also have a higher risk (lifetime risk of 10%-20%). If you fall in this group, you will be asked to undergo surveillance mammograms every year, starting in the year the diagnosis has been established.
There are a few women who have been treated with chest or mantle radiation for Hodgkin’s lymphoma at a young age. These women are also at increased risk (cumulative risk 20% to 25% by age 45) for breast cancer and should start screening mammograms 8 years after radiation but not before the age of 25.
All the above examples I have mentioned, are of women with a higher risk of breast cancer. Most women with no genetic predisposition, family history or personal history of breast cancer or high-risk changes, fall within the “average” category of risk of developing breast cancer. For these women, the ACR recommends starting screening mammograms at age 40. Having a couple of family members diagnosed with post-menopausal breast cancer does not necessarily mean that your personal breast cancer risk is elevated. Remember, the number one risk factor for developing breast cancer is being female.
Only women with a lifetime risk of 20% or greater should start breast cancer screening at age 25-30. In addition to screening mammograms, supplemental breast cancer screening examinations such as breast MRI are also recommended for women with high-risk. These additional screening tests do not replace annual screening mammography but are a useful adjunctive imaging modality to detect breast cancer.
When to begin annual screening mammography can be confusing for a lot of women. For women with average risk, ACR guidelines recommend starting screening mammograms at age 40. If you are unsure or if you think you have a higher risk for developing breast cancer, meet a specialist who will advise you about when you should start breast cancer screening. Remember, mammograms don’t prevent breast cancer, but they can save lives by finding the cancer as early as possible. After all, finding breast cancer early means a better chance of survival!
