Breast Screening
Breast screening and younger women
The NHS Breast Screening Programme doesn't routinely include women under fifty, but in some areas women aged 47 to 49 receive invitations for screening. This is part of a study looking at whether to extend the breast screening age range. Mammograms are less effective in pre-menopausal women, possibly because the density of the breast tissue, making it more difficult to detect problems. The breast cancer is also less common in younger women. However, some women may be invited for screening through the 'high risk screening programme' below the age of 50 at the request of clinical geneticists or oncologists if they meet the level of risk as defined by the programme.
“Breast cancer is extremely rare in women in their teens or early twenties and uncommon in women under 35. After this age the risk begins to increase, rising sharply after the menopause” NHS Breast Screening Programme 2015.
The average age of the menopause in the UK is 51 (NHS Choices 2015). Studies have shown that digital mammography is better for screening younger women (under 50) and women with denser breasts, and is equally effective as film mammography in older women (see ‘Diagnostic mammograms in the UK’ and the DMIST study.
As women pass the menopause, the glandular tissue in their breast 'involutes' and the breast tissue is increasingly made up of only fat. This makes mammograms clearer and their interpretation more reliable. Breast cancer is also far more common after the menopause and the risk continues to increase with age.
Women who are not in the national screening age group can discuss with their doctor whether they should have regular screening before they are 50 if they have a close relative who had breast cancer at a young age, or has several members of the family with breast cancer. Women concerned about a specific breast problem or otherwise worried about the risk of breast cancer can ask their GP to refer them to a hospital breast clinic.
Several women appreciated that mammograms can be unreliable in younger women because their breast tissue is dense, and so routine mammograms aren't started before the age of 50.
She says that, for medical reasons, fifty is a good age to start breast screening.
She says that, for medical reasons, fifty is a good age to start breast screening.
No, I mean I accept that, you know, the medical reasons for not being able to properly image breast tissue in younger women makes it very, very difficult to screen. I mean, obviously, younger women who can feel a lump, it's entirely outside of screening but from a screening perspective, I think it's probably the right age. I mean, they've extended the age upwards now, at least, which is a good thing. But I accept the medical reasons for not being able to screen at a younger age.
A few younger women, whose breast cancer couldn't be seen on a mammogram, discussed other diagnostic tests that they'd had (see 'Referral to a breast clinic'). Several believed that both mammograms and ultrasound scans should be used on younger women since ultrasound scans could sometimes detect tumours in younger women that mammograms couldn't. A few women thought that better evidence for the reliability of mammograms in this age group was needed, before lowering the breast screening age. Research is being carried out to establish whether screening women from age 40 has benefits. Some people wondered whether the NHS was trying to save money by not screening women under 50. Many felt strongly that younger women should be breast aware.
She thinks younger women with breast concerns should have both a mammogram and an ultrasound scan.
She thinks younger women with breast concerns should have both a mammogram and an ultrasound scan.
The mammograms you had right at the beginning didn't show anything did they?
No, nothing.
It was only the ultrasound?
Yes.
So, how do you feel about going for mammograms?
I didn't like going for mammograms on their own, you know, without ultrasound. I didn't mind mammograms at all because I was advised that I needed them. I didn't have a problem with them. I have a problem with them now because, as I say, they are unreliable and I think they are wrong and, you know, there is a lot of hoping involved that the mammograms and manual exams are enough and given how lumpy my breasts are I think it's not optimal treatment.
Would you like to say anything about mammograms? For example, some people might say "younger women below the age of 50 should go for mammograms"?
The only problem is that so many of them are difficult to read, if there is a real good reason to have one and the doctors will know, have one. Don't have one on it's own, have an ultrasound as well.
Many believed that women with a family history of breast cancer should attend for screening before 50 and some had started regular breast screening before then because of a family history of breast cancer. A few talked about family history and the possibility of being tested for faulty genes that can cause breast cancer.
She started having mammograms before she was fifty because of a family history of breast cancer.
She started having mammograms before she was fifty because of a family history of breast cancer.
Because of that I was under more regular screening. I was started on mammograms before I reached 50, which locally is the age at which they do it. They were doing them every two years, and that was fine.
She discussed a genetic cause with her family and decided against being tested for a faulty gene.
She discussed a genetic cause with her family and decided against being tested for a faulty gene.
What happened was he [GP] referred me to the breast care unit and to the consultant there, and he wanted to do a family history thing, and I was finding out, wanted to find out about genetic testing, that was what originally started. And by the time the consultant had looked at all the risk history and the factors between the consultant and what they've told us - the fact that I could have had genetic testing to find if I'd got a faulty gene, but if we've got that information, what are we going to do with it anyway? And because genetic testing took such a long time he suggested then to go on the screening program would be the best thing for me. But genetic testing is something I have discussed with my consultant, and it is something that I want to do for the benefit of my own daughter really, and my sister - my one sister in Canada is on a genetic testing program.
I don't know how they do it, but they just kind of touch base with her every now and then, they're still looking. I don't know how it works but they haven't found anything that they can say yes, she's got this faulty gene, because she's got three daughters, and she's very aware of this. It's something that I'll want to do, because if there is a faulty gene I need to know for my daughter's sake, because when she's old enough I'll get her tested, and then at least she'll be in a position to be able to make the decision earlier on, rather than waiting to have it... But we don't know yet until they've done the genetic testing. It could be that it's just very, very bad luck that four sisters out of five have had the breast cancer but the chances are it's more than likely going to be genetic.
A very small number – between 5 –10% - of breast cancers are thought to be related to faulty genes that run in families (Macmillian Cancer Support March 2016). The main genes linked to breast cancer are BRCA1, BRCA2 and TP53. People with a strong family history of breast or ovarian cancer could have inherited a faulty cancer gene. However, because breast cancer is the most common cancer in women, it's possible for it to occur in more than one family member by chance.
Women may want to see their GP and be referred to a specialist genetics service if they have:
- three close blood relatives (from the same side of the family) who developed breast cancer at any age
- two close relatives (from the same side of the family) who developed breast cancer under 60
- one close relative who developed breast cancer aged 40 or younger
- a close male relative with breast cancer
- a close relative with breast cancer in both breasts
- If there is also ovarian cancer in the family.
Screening for women with increased risk of breast cancer due to a family history is being implemented across the UK. This involves both mammography and MRI.
An MRI scan is another type of test that is sometimes used for screening women at high risk of breast cancer. MRI scans use magnetism rather than radiation to pick up changes in the breasts.
MRI scans aren’t routinely used to screen women for breast cancer but NICE (The National Institute for Health and Care Excellence) recommend the use of MRI breast screening in young women under 40 who are at very high risk (e.g. women who have one of the breast cancer susceptibility genes). MRI has been shown to be a more sensitive test than mammography in this group of women.
Women who are known to have a genetic mutation should be offered annual MRI surveillance if they are:
- BRCA1 and BRCA2 mutation carriers aged 30–49 years.
- TP53 mutation carriers aged 20 years or older - NICE CG164 June 2013
Some people had their first mammogram before fifty in a private health care scheme at work screening younger women.
Several women, who had had benign conditions earlier in life, also had mammograms before 50. A few women had their first mammograms before 50 because they took part in research on breast screening.
She had her first mammogram before fifty in medical research on breast screening.
She had her first mammogram before fifty in medical research on breast screening.
How did you get involved with this research programme?
Through my Nan, through my Grandmother. She was a, or we were asked if we would be involved and we said yes.
And what does that involve, does it mean having mammograms every three years?
It did but then because I was such a low risk [laughs], which seems funny now ... but they took me off the programme and they said "well you're not at any greater risk".
Oh, were they looking at family history or?
Yes, yes.
So, at what age did you have your very first mammogram through this Oxford research group?
I was probably about maybe 40, 38, 40.
Some women thought that the UK Breast Screening Programme should start before the age of 50 for all women. Several believed that the number of younger women diagnosed with breast cancer was increasing, and that, if younger women were screened, fewer of them would die. However, one woman wondered whether it was just that she had become more aware of breast cancer among young women after hers had been diagnosed in her 30s.
She believes that fewer women would die from breast cancer if routine breast screening started before the age of fifty.
She believes that fewer women would die from breast cancer if routine breast screening started before the age of fifty.
So would you recommend women to go for screening before the age of 50 if they could?
Absolutely, if you can. I mean I just, I met so many women when I was having chemotherapy who were in their early forties and mid forties and I was probably the oldest one of that particular lot that was going through it at the time. And I was only fifty and I think that the NHS must be missing a lot of patients and a lot of cases. And I think that certainly if there is a history of breast cancer in the family, they should be going from a very early age.
And I think routine screenings should start at forty. I really think that we're losing too many people younger and there's no need for it. I mean okay we can't cure breast cancer but we can extend peoples lives and its' not acceptable, and I know that there are lots of other cancers and I know there is limited funds available.
But surely it's going to be cheaper to screen and treat earlier than it is to treat later. You know maybe so many families wouldn't be left without mums, sisters, daughters and husbands, because obviously men can develop breast cancer as well. And I think, I, yes I do, I think it should be definitely given early and I'd like to see it on the NHS yearly from the age of forty. How practical that is I don't know but that's what I'd like to see.
Some people felt that the best time for women to start having routine mammograms would be in their 40s, around the onset of menopause. People who had been diagnosed with breast cancer in their 30s recommended that women should go for screening in their thirties because early detection of breast cancer can mean less treatment and a better chance of a successful recovery. One younger woman recalled her shock at having breast cancer as she didn't know that women in their 30s could get it. She said she would have requested screening privately if she had realised she was at risk. She also discussed feeling isolated as she didn't know other women of her age to talk to. Three British Indian women also wanted to discuss their experiences with women in similar situations. These women stressed the benefits of counselling and joining a support group (see our breast cancer in Women section).
She thinks that routine breast screening should start earlier, around the onset of menopause.
She thinks that routine breast screening should start earlier, around the onset of menopause.
She discusses feeling isolated as she did not know women of her own age with breast cancer.
She discusses feeling isolated as she did not know women of her own age with breast cancer.
I think also you get very struck by the feeling of, you know "I'm thirty-nine. This doesn't happen to thirty-nine year old's. Why me, why on earth, you know is this happening? Did I do something? Was it junk food I ate? Was it the aspirin I took? Was it, you know birth control?" And nobody could say what it was. Nobody. And I think that's a very frightening part of it. And I think there's also, oddly enough, a sense of embarrassment. I had the sense that I'm the only mother on the school run with cancer. You know, it was something that I felt very strongly in the beginning.
She wanted to discuss her experiences with other young women in similar situations.
She wanted to discuss her experiences with other young women in similar situations.
And then after my operation I was - I kind of wanted to find someone that was local, that was Indian, that had had a mastectomy, that was similar to my age. Which a breast care nurse found, she kept records and she put me in touch with a lady that's local and she rang me up, and she was really useful and really helpful. She'd had a mastectomy and she'd had the same chemo that I was having, so it was really good talking to her, and she was very positive.
She had very young children, her son was only three. It was nice to think you're dealing with it, it helps.
Several younger women with breast cancer noted that some of their concerns were different to older women with breast cancer. Talking to young children about breast cancer, breast reconstruction and fertility were some of the issues important to younger women.
Some women who'd had breast cancer wished they had started breast screening earlier. One of these had her first mammogram privately at 40 and the second one privately at 50. She wished she had been screened in the intervening years because her cancer might have been detected earlier. Some women felt that screening every three years was too infrequent.
Wishes she had continued having breast screening between the ages of forty and fifty.
Wishes she had continued having breast screening between the ages of forty and fifty.
So I'd had this one, so I knew what to expect then. At that time I didn't, when I had this original one I didn't know what to expect but when I went back, when I was fifty, I knew what to expect. The only thing I wish I'd done was kept it up in between.
Many women who had had breast cancer expressed concern for their daughters. Some wanted their daughters to be screened before the age of 50. A few were unsure how to discuss this subject with their daughters. One woman said that her young daughter did not want to discuss having mammograms yet. Another woman's 24-year-old daughter was extremely anxious about getting breast cancer.
She is unsure whether to discuss breast screening with her daughters.
She is unsure whether to discuss breast screening with her daughters.
Says that her daughter is extremely anxious that she might get breast cancer.
Says that her daughter is extremely anxious that she might get breast cancer.
I've got the concern now, because I've had it, the concern is for my daughter. Because she's convinced herself that she is going to get cancer. She's convinced herself that she is going to get breast cancer and she's been told that she can't go for a mammogram until she's older again, whereas I think....
How old is she?
She's 24. Whereas I think that if there is a history of it in the family, again that, she should be allowed to, she should have the option.
Have you discussed this with your daughter?
I have, yes.
She feels convinced or she's worried?
She feels convinced that she's going to get it, yes.
So does she check herself and...?
She checks herself, but she's actually become depressed over it. It's had an effect on her that it, depressed, you know, she suffers with depression and I mean when she goes to the doctors and asks she always gets a negative attitude because she's so young, don't worry.
Women, of any age, who have a concern about their breasts are encouraged to visit their GP and would be referred to a breast clinic if appropriate.
Last reviewed March 2016.
Last updated March 2016.
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