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.

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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.

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.

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.

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.

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 section).

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.

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.

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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