“It just got too hard.”
A League of Their Own
Dottie: “It just got too hard.”
Jimmy Dugan: “It’s supposed to be hard. If it wasn’t hard, everyone would do it. The hard is what makes it great.”
Navigating the hard shouldn’t have to be a solo sport. The women we know dominate careers, run a house, manage the kids’ schedules, coordinate a parent’s appointments, and still call back the friend who’s having a hard week. They know how much they give. Setting aside time for themselves is the hard part, so their own checkup is usually the thing that gets ignored.
Breast cancer is the most common cancer in American women after skin cancer, and about 1 in 8 will be diagnosed in her lifetime (American Cancer Society, 2026). Found early, it’s one of the most treatable cancers there is, and the way we screen for it has changed a lot in the last two years.
THE BIG IDEA
Breast cancer screening starts with a conversation at 25.
At 25, breast cancer is rarely on the list. Women are thinking about their period, birth control, maybe a first pregnancy. That’s the age when the American College of Radiology recommends every woman have a formal breast cancer risk assessment, especially women with a family history of breast cancer, Black women and women of Ashkenazi Jewish descent (ACR, 2023).
A risk assessment at 25 doesn’t mean a mammogram at 25. It means finding the women at higher risk early enough to build the right screening plan. If you’re past 25 and no one has had this conversation with you, you should start it now with your GYN or primary care physician.
For women at average risk, mammograms start at 40, and the two main guideline groups differ on how often. The American College of Radiology recommends one every year. The U.S. Preventive Services Task Force recommends one every two years from 40 to 74 (USPSTF, 2024). More cautious leans to yearly. Some physicians also offer a baseline mammogram at 35, and insurance coverage for it varies.
Since September 2024, the FDA has required every mammogram report to state whether your breast tissue is dense. Nearly half of women 40 and older who get mammograms have dense tissue (National Cancer Institute). Dense tissue and tumors both look white on a mammogram, so cancers are harder to see, and dense tissue also raises risk on its own (FDA). Radiologists grade density from A to D, and a C or D counts as dense.
A few reasonable-sounding beliefs get in the way.“
No one in my family has had it.” Having a mother, sister or daughter with breast cancer nearly doubles your risk (ACS), but a family tree without it doesn’t clear you, and family health stories are often incomplete.
“I’m too young.” Age is only one input. A risk assessment by 25 tells you whether you need to start screening well before 40.
“My mammogram was normal.” A normal mammogram is good news, but in dense tissue it can miss cancers that other imaging finds (the chart below shows how many). A new lump or change still needs a doctor’s look, even if your last mammogram was clear.
Three Takeaways from the Latest Breast Cancer Research
01
Know your density.
Your mammogram report grades it A to D. A C or D makes cancers harder to see and raises risk.
02
Know your TC score.
Your Tyrer-Cuzick score estimates lifetime risk. At 20 percent or higher, guidelines support adding a yearly MRI.
03
Ask what else belongs.
Genetic testing and extra imaging depend on your history. Ask whether either fits your plan..
Three things to bring to your next appointment.
THE SCIENCE
What the Research Shows
>99% / 32%
Survival by Stage.
Five-year relative survival for localized versus distant breast cancer, diagnosed 2015 to 2021. (ACS, 2026.)
1.4%
Yearly Rise Under 50.
Annual increase in breast cancer incidence among women under 50, 2012 to 2021, double the rate for women 50 and older. (ACS.)
Your Tyrer-Cuzick score. The Tyrer-Cuzick (TC) model estimates your lifetime risk of breast cancer from your age, your personal and family history, past biopsies and, in newer versions, breast density. Density alone doesn’t tell the whole story, and the TC score puts it in context. Many imaging centers calculate it and print it on the mammogram report, yet it often goes undiscussed. If yours isn’t there, ask where it is and what it is.
At 20 percent or higher. High-risk guidelines support a yearly breast MRI starting between ages 25 and 30, with yearly mammograms added at 30 (ACR, 2023). Many high-risk breast clinics alternate the two, so you’re imaged every six months, and insurance often covers that schedule when your TC score is above 20 percent.
Family history. It includes both parents. BRCA gene variants pass down from fathers as often as from mothers (NCI), so relatives on your father’s side count just as much. If breast, ovarian, pancreatic or prostate cancer runs on either side, ask your GYN or PCP whether genetic counseling and testing for BRCA1, BRCA2 or other genes makes sense for you.
The same women had both tests. Abbreviated MRI found more than twice as many invasive cancers and also produced more false alarms. Whether it belongs in your plan depends on your overall risk. (Comstock et al., JAMA, 2020.)
THE TESTING GUIDE
Breast Screening Options
What each test is for and who it’s meant for. Beyond a yearly mammogram, the right add-ons depend on your TC score, density and family history.
Mammogram (2D or 3D). An X-ray of the breast, and the only screening test shown to lower breast cancer deaths. 3D takes thin slices that see through overlapping tissue. Yearly from 40 under ACR guidance, which Sperity’s physicians follow, and from 30 for women at high risk. Learn more
Breast ultrasound. Sound waves, no radiation. In dense tissue it can find cancers a mammogram misses, with more callbacks as the trade-off. The USPSTF calls the evidence insufficient to add it for density alone, and the ACR supports a risk-based approach, so ask whether it fits yours. Learn more
Breast MRI. The most sensitive breast test, using magnets and an IV contrast dye. For women with a TC score of 20 percent or higher or a high-risk gene, once a year starting between 25 and 30. A shorter abbreviated MRI is another option to ask about for dense breasts. Learn more
Contrast-enhanced mammography. A mammogram with IV contrast that highlights areas with extra blood flow. Worth asking about when MRI is recommended but not available. Learn more
Molecular breast imaging. A radioactive tracer and special camera, offered at a few centers. Higher radiation, and not for routine screening. Learn more
Bexa. A handheld device cleared by the FDA to document a lump already found. Not a screening test.
Thermography. An infrared heat map of the skin. The FDA says it is no substitute for a mammogram. Learn more
Genetic testing. A blood or saliva test for inherited genes such as BRCA1, BRCA2, PALB2, CHEK2 and ATM. If cancer runs on either side of your family, or you have Ashkenazi Jewish ancestry, ask your GYN or PCP about it. It’s usually done once, with a genetic counselor, and a positive result moves screening earlier. Learn more
Self-awareness. Know how your breasts normally look and feel. A new lump, dimpling or nipple change needs a doctor’s look right away, even after a normal mammogram. Men get breast cancer too, about 2,670 in the U.S. this year, often found at a later stage (ACS). Learn more
SCREENING BY RISK LEVEL
Four starting points, each beginning with a risk assessment by 25. Your physician can help you find yours.
The Practice
What to Do This Month
Start the conversation. If you’re 25 or older and no one has assessed your breast cancer risk, ask your GYN or PCP about it at your next visit
Find your TC score and density. Both often appear near the end of your mammogram report. If the TC score isn’t there, ask where it is and what it is, and share both with your Sperity physician.
Book your mammogram and map your family. If you’re 40 or older, schedule this year’s mammogram. Then list relatives on both sides who had breast, ovarian, pancreatic or prostate cancer, and roughly how old they were.
Go with someone. Book your mammogram the same week as your sister, mother or a close friend. If you’re a husband, son or brother, ask the women in your family when they last had one, and if your daughter is 25, make sure she’s having the conversation.
THE BIGGER PICTURE
The Long View
Those women were tough, but what kept them going was each other. The later breast cancer is found, the harder it is to treat. Knowing your density and your TC score, and asking whether genetic testing or extra imaging belongs in your plan, all help find it sooner.
Book your own appointment this month. Then ask the women in your life when they last had theirs. Here’s to many more Octobers together.
Additional Reading
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