When to start breast cancer screening, and how to do a self-exam

When you should start screening for breast cancer depends on your personal risk, so it helps to know where you fall.

Most women are considered average risk, meaning you don’t have a personal history of breast cancer or a strong family history of it. It also means you don’t carry a gene mutation known to increase risk, such as BRCA, and you didn’t have radiation therapy to your chest before age 30.

If you’re average risk, you are best off starting a yearly mammogram at age 40, and you should absolutely begin by age 45. Once you reach 55, you and your doctor can decide whether to keep going every year or switch to every other year.

You’re considered high risk if you carry a BRCA mutation, or if a parent, sister or other first-degree relative has BRCA and you haven’t been tested yourself. Having radiation therapy to your chest before age 30 also puts you in this group. So does having Li-Fraumeni syndrome, Cowden syndrome or Bannayan-Riley-Ruvalcaba syndrome, or having a first-degree relative with one of them. If you’re high risk, you should get both a breast MRI and a mammogram every year beginning at age 30. If you aren’t sure which group you belong to, your doctor can help you figure it out.

While the medical community is currently divided on how useful breast self-exams are, they are a convenient, free tool you can add to your personal screening strategy. It’s how many people find their first warning sign. In fact, one study found that nearly four in 10 breast cancers were first noticed by the women themselves.

Start by looking at your breasts in a mirror with your hands on your hips. Check that they’re their usual size, shape and color, and look for any visible distortion or swelling. Dimpling, puckering, bulging, nipple inversion, rash or fluid leaking from one or both nipples should be brought to your doctor’s attention. Next, raise your arms above your head and check for the same things.

After the visual check, feel for lumps both lying down and standing or sitting. Use the pads of your first few fingers and move in firm, small circles. Cover each breast from your collarbone to the top of your stomach, and from your armpit to your cleavage.

Breasts can be naturally lumpy, so don’t panic if you feel something. If you menstruate, you may want to wait until after your period to see whether the lump or change goes away on its own. But if you find a new lump that sticks around, don’t hesitate to call your doctor and have it checked.

Breast cancer is very treatable when it’s caught early. Regular mammograms and getting to know your own body give you the best chance of finding it at that stage. When in doubt, schedule time with your doctor.