October is Breast Cancer Awareness Month

Let’s start the month with more than “wear pink.”

Let’s talk about screening, knowing your risk, knowing your body, and shared medical decision-making.

One thing that often surprises patients is that breast cancer screening guidelines are not all the same.

For average-risk women, the U.S. Preventive Services Task Force (USPSTF) recommends mammography every 2 years from ages 40–74. National Comprehensive Cancer Network (NCCN) and American College of Radiology (ACR) recommend annual screening beginning at age 40, while American College of Obstetricians and Gynecologists (ACOG) supports screening every 1–2 years beginning at 40. The differences largely come down to how each organization weighs earlier detection against potential harms such as false-positive results, additional imaging, biopsies, and overdiagnosis.

This is exactly why shared decision-making matters.

As a provider, I generally align most closely with the NCCN model because I appreciate its proactive, risk-based approach. It starts with understanding the patient’s risk, not simply applying the same screening schedule to everyone.

But guidelines are meant to guide the conversation, not replace it.

Here are a few things I want every woman to know:

• For many women, the conversation about routine mammograms starts at age 40. However, for some women, this conversation may need to take place much sooner. Talk with your provider about your risks and what screening approach makes the most sense for your individual situation.

• Know your family history. Breast cancer risk assessment goes beyond asking whether your mother had breast cancer. Family patterns of breast, ovarian, pancreatic, prostate, and other cancers may be important. Some patients need genetic counseling, earlier screening, or additional imaging.

• Know your breast density. Dense breast tissue can make cancer more difficult to see on a mammogram and is also associated with increased breast cancer risk. Since September 2024, mammography facilities nationwide are required to include breast-density information in patient reports.

• Dense breasts do not automatically mean everyone needs an ultrasound or MRI. This is another area where guidelines differ, so your breast density should be considered alongside your overall risk and discussed with your provider.

• Know what is normal for YOUR body. Screening recommendations are for people without symptoms. A new breast or underarm lump, swelling or thickening, skin dimpling, nipple changes or discharge, a change in breast size or shape, or persistent breast pain deserves evaluation...regardless of when your last mammogram was.

• Know your personal risk. Some women need a completely different screening plan because of genetic risk, significant family history, previous high-risk breast findings, prior chest radiation, or an estimated lifetime breast cancer risk of 20% or greater.

  
  

We absolutely have to be judicious with healthcare resources. Screening has benefits and potential harms, and more testing is not automatically better care.

But screening mammography saves lives, and early detection matters. The goal should be educated providers, informed patients, appropriate risk assessment, and a thoughtful conversation about the best screening plan for the person sitting in front of us.

Providers: Educate. Assess risk. Discuss the options.

Patients: Ask questions. Know your family history. Know your breast density. Know your body.

And ladies…

GET YOUR MAMMOGRAMS

Sources: National Comprehensive Cancer Network (NCCN). Breast Cancer Screening and Diagnosis Guidelines, Version 1.2026.• U.S. Preventive Services Task Force. Breast Cancer: Screening Recommendation Statement, 2024.• American College of Radiology. ACR Appropriateness Criteria® Female Breast Cancer Screening: 2025 Update.• American College of Obstetricians and Gynecologists. Breast Cancer Screening Guidance, 2024.• U.S. Food and Drug Administration. Mammography Quality Standards Act Breast Density Notification Requirements.• Centers for Disease Control and Prevention. Symptoms of Breast Cancer.

For health education purposes only. Screening recommendations should be individualized based on personal and family history, age, breast density, genetic risk, prior findings, and other clinical factors.