The NHS Breast Screening Programme has now widened the age range for breast screening to include women aged 47-73. The NHS Breast Screening Programme did not include women under fifty because mammograms are less effective in pre-menopausal women, and possibly because the density of the breast tissue, making it more difficult to detect problems. The incidence of breast cancer is also lower in younger women.The average age of the menopause in the UK is fifty (NHS Breast Cancer Screening Programme). Studies have shown that digital mammography is better for screening younger women (under fifty) 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 and who have a close relative who had breast cancer at a young age, or has several members of the family with breast cancer, can discuss with their doctor whether they should have regular screening before they are 47. 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 are not started below the age of 47.
A few younger women, whose breast cancer could not be seen on a mammogram, discussed other diagnostic tests that they had 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 could not, but a few women stressed that, before lowering the breast screening age, better evidence for the reliability of mammograms in this age group was needed (DMIST study). Research is being carried out to establish whether screening women from age forty has benefits. Some people wondered whether screening had not been offered on the NHS to women under fifty because of financial constraints. Many felt strongly that younger women should be breast aware (see 'Breast awareness').
Many believed that women with a family history of breast cancer should attend for screening before fifty; 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.
"A very small number – between 5–10% - of breast cancers are thought to be related to faulty genes that run in families. The two main genes linked to breast cancer are BRCA1 and BRCA2. People with a strong family history of breast or ovarian cancer could have inherited a faulty cancer gene. But breast cancer is the most common cancer in women in the UK, so even if a woman has one or even two elderly family members with breast cancer, it is unlikely that she will carry one of these gene changes (mutations)."(
Macmillan Cancer Support)
Women may want to see their GP and be referred to a family cancer clinic 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. (For more information see Macmillan Cancer Support).
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 recommend the use of MRI breast screening in young women under 40 years who are at very high risk (eg 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
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 fifty. A few women had their first mammograms before fifty because they took part in research on breast screening.
Some women thought that the UK Breast Screening Programme should start before the age of fifty for all women (it now starts at 47). 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 thirties.
Some people felt that the best time for women to start having routine mammograms would be in their forties, around the onset of menopause. People who had been diagnosed with breast cancer in their thirties 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 did not know that women in their thirties 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 did not 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 Healthtalkonline - Breast cancer website).
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 (see Lavender Trust website).
Some women who had had breast cancer wished they had started breast screening earlier. One of these, who had had her first mammogram privately at forty and the second one privately at fifty, 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.
Many women who had had breast cancer expressed concern for their daughters. Some wanted their daughters to be screened before the age of fifty. 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.
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 approriate.
Last reviewed November 2010.
Last updated November 2010.
