In 2015, the year I turned 40, the American Cancer Society updated its guidelines for breast cancer screenings. Instead of urging women to get mammograms beginning at 40, it would now recommend yearly mammograms beginning at age 45, and then every two years from age 55 on.
I was greatly relieved by this news. I was a little more than a year into a wildly busy job at a news media startup. I had already taken time off in that period for regular check-ups with my primary care physician, my gynecologist, my dentist, my eye doctor — plus time away to bring my young daughter to her appointments with the pediatrician, the dentist, and the ENT who saw her multiple times that year before deciding to take out her adenoids.
I was appointment-ed out.
To be clear, I wasn’t cavalier about my health. Just ask my cousins who went into medicine; I’m certain I spent way too much of my mid-30s seeking reassurance from them on the phone whenever I had bad headaches or weird stomach pains — all of which easily, and no doubt correctly, were chalked up to stress. But I had never once worried about breast cancer; it simply wasn’t on my radar screen.
My mother happened to call me the day those new ACS guidelines came out, and it came up as a topic of conversation. I told her I planned to follow the new recommendations. And why not? There was no history of breast cancer in my family. None of my close friends had dealt with it — yet. Scheduling an apparently unnecessary medical exam between important meetings and aftercare pick-up seemed pointless.
My mother rarely voices opinions about how I should run my life. But she was clear on this: “Please don’t wait,” she said.
I didn’t understand why this was the issue that made her want to interfere with my decisions. “I just know too many women who got diagnosed with this in their 40s,” I remember her saying. “Catching it early is important.” I allowed her that, but I still was pretty sure I’d be holding off until age 45.
A week or two later, I was back at the gynecologist for my annual exam. “You’re 40,” she said, looking at my chart. “Time for a mammogram.”
I was incredulous. “I heard the guidelines have changed?”
She was unwavering. “We go at 40,” she said. She wrote out the order and recommended an imaging center nearby.
I love my OB-GYN. I’ve never had a doctor I’ve trusted more, nor one who has ever seemed as concerned about me as a patient. She always inquires about my mental health along with my physical health; we talk about our children and the more absurd demands of family life. Unlike any other doctor I’ve seen in my adulthood, she spends more time with me in her exam room than I spend in her waiting room. There was no way I could cross her. The next day, I scheduled my first mammogram.
The mammogram itself was uneventful, but I was told I would need to come back for an ultrasound; my breast tissue was dense, and they needed the best pictures possible, especially since this was my baseline screening. Unfortunately there wasn’t room on the ultrasound schedule that afternoon. I would need another appointment.
That’s what I mainly remember from my first screening — not that it was scary (it wasn’t) or all that painful (ditto), but that it had created yet another scheduling headache for me.
I did return for the ultrasound, which was largely unremarkable. There were two small areas of interest, probably cysts, and I was free to go about my life until it was time for the next screening. The next year, wise to the process, I scheduled the mammogram and ultrasound together. All was well.
At age 42, I returned for my third screening, by then feeling like a pro. But that time, the radiologist saw something he didn’t like. I would need to come back for a biopsy.
The only option I had for treatment of my breast cancer was a mastectomy. I had two tumors, far enough apart to make a lumpectomy-with-radiation plan unadvisable. The good news was my cancer was caught very early. Both tumors were tiny, and there was no evidence of spread to my lymph nodes or anywhere else. I was put on tamoxifen, and once I finished with the breast reconstruction process, that would be pretty much that.
I still get annual mammograms and ultrasounds, as I had opted for a single mastectomy. (It’s the one time of year I regret that decision, but only because of the night or two of anxiousness beforehand.) I also get yearly breast exams from my OB-GYN — who, it turns out, also was diagnosed with breast cancer in her 40s, which I was unaware of until she had shared this with me during my own odyssey with the disease. Her resoluteness about screenings beginning at 40 now made perfect sense to me.
It also made sense to me when the U.S. Preventive Services Task Force, which since 2016 had been recommending breast cancer screenings beginning at age 50, changed its guidance this May to advise that all women have their first mammogram at 40. I felt both saddened and validated to learn of the task force’s reasons for lowering the recommended age for screening, among them that the rate of invasive breast cancer cases among women in their 40s had risen 2% per year from 2015 to 2019, a noticeably faster increase than was observed over the previous 15 years.
Why the spike? Does it have to do with environmental factors? Better detection? We need more data. Whatever the cause, regular screening, it is widely agreed, is an appropriate response. The question is when to begin those screenings, and whether they should be conducted annually or every other year.
When the topic comes up with younger friends or colleagues, or other people who know me, I simply share the timeline of my diagnosis with them. Usually it’s enough to convince them that 40 is a good age to start annual screenings.
But the fact is that there are multiple medical bodies, each with its own set of guidelines. Determining which one to follow strictly comes down to individual choice, ideally made in partnership with a good doctor. And of course guidelines from individual organizations can vary depending on whether patients are carriers of the genes known to cause breast cancer, or have other risk factors.
It can all be rather confusing. So I’m glad we have a plan for my teenage daughter as she gets older. Genetic testing I received after my diagnosis confirmed I don’t have either of the BRCA genes. Based on the guidance we’ve received so far, she’ll need to start her screenings at 32, one decade prior to the age at which her mother was diagnosed. That guideline may change of course, but for now it sounds to me like a perfectly reasonable approach to take — as do yearly mammograms beginning at 40 for women without other risk factors.
Heather Landy is executive editor at Quartz, the global business news site. She lives in New York.
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