How Younger Women Can Access Mammograms

Fact checked by Nick Blackmer

Key Takeaways

• Most women do not start receiving mammograms until after they are between the ages of 40 and 50, based on existing recommendations.

• If you are younger than 40 and seeking a mammogram, your personal risk factors will help determine whether you’ll be granted one and whether insurance will cover it.

• Your provider is the best person to help you work through insurance barriers.

In the quest to detect breast cancer early, mammograms have been a key tool for decades. While guidelines for mammograms have varied by organization, most recommend that women start receiving screening mammograms at age 40.

Recently, the U.S. Preventive Services Task Force (USPSTF) drafted guidance recommending that women begin mammograms at age 40, down from age 50, in response to an increase in breast cancer numbers among younger women. The American Cancer Society, meanwhile, recommends that women begin screening mammograms at age 45.

For women under 40, accessing this important screening tool may be a less-than-straightforward process. Many factors come into play: personal and family history, risk profile, and insurance coverage, just to name a few.

Related: Starting Mammograms at Age 40 Could Help Track Important Breast Density Changes

The first step for younger women interested in having a mammogram is to establish the reason why. Has a lump in the breast been discovered, or is there another potential abnormality? Have relatives been diagnosed with breast cancer? Is it simply a data point that seems useful? No matter the motivation, it’s important to connect with a healthcare provider to discuss the issue.

“As an organization, we support women having conversations with their providers to determine their personal risk,” Molly Guthrie, vice president for policy and advocacy at Susan G. Komen, a breast cancer organization focused on patient advocacy, resources, and funding, told Verywell. While most insurance providers, including Medicare and Medicaid, will cover screening mammograms for women over 40, "for people under 40, it’s a little more complicated," she added.

Takeaway

While the organizations making mammogram recommendations refer to patients as “women,” it’s important to know that not everyone who needs a mammogram identifies as a woman.

Insurance Coverage Is a Major Hurdle

The biggest barrier a younger woman is likely to face is refusal by her insurance company to authorize a screening mammogram.

“Even if your doctor says you’re at risk, insurance doesn’t have to cover it,” Guthrie said. “Insurance companies often try to find ways to deny patients access to that additional imaging.”

Ironically, Guthrie points out, it can be better for a young woman to be uninsured than to have insurance if she’s seeking a mammogram. This is because women of any age without insurance are covered under the National Breast and Cervical Cancer Early Detection Program. The program, managed by the Centers for Disease Control and Prevention (CDC), allows low-income women who don’t have insurance, or who lack adequate insurance, to get the screenings they need.

Related: Find a Low-Cost or Free Mammogram Near You

Pull in Your Providers

If insurance is saying no to a mammogram, it’s time to get a health provider involved, Guthrie said. Having a physician make the request for approval with an insurance company typically streamlines the process.

The involvement of her healthcare team has been key for Ashley Dedmon, a 37-year-old Houston resident with a strong family history of breast cancer. At age 22, after her mother died from the disease and her father was diagnosed with prostate cancer, Dedmon contacted her ob/gyn to update her on the situation. The doctor suggested Dedmon receive genetic counseling to assess her own risk.

A genetic test revealed that she carried the BRCA2 gene mutation, which meant she was at significantly elevated risk of having breast cancer. She began getting regular mammograms at that early age, as well as ultrasounds and MRIs, and ultimately opted for a double mastectomy at 31. 

Related: What Young Adults Need to Know About Breast Cancer

Although she was able to access genetic testing relatively easily, the path to getting the ongoing screenings and treatment Dedmon needed wasn’t always smooth.

“I did encounter roadblocks,” she told Verywell. “It took me advocating for myself, and also educating my health insurance company about my BRCA2 gene and the legislation that supported my standard of care as a high-risk woman. My providers played a key role in helping me to provide the insurance with the necessary information so that I [could] make the medically necessary decisions to protect my health.”

As a person who knew early on that she was at high risk for breast cancer, Dedmon had extra motivation to push for the care she needed and get her providers and insurance company on board. However, the journey for younger women who don’t necessarily have risk factors but are interested in getting mammograms is likely to be different.

“Typically, by the time a young woman gets to a breast cancer oncologist, they’ve already been through the insurance fight related to screening,” said Susan Brown, RN, Komen’s senior director of health information and publications, referring to women like Dedmon who are determined to be at higher risk of having breast cancer. For the rest, she said, “an ob-gyn or family doctor would be the point person who would have to assess what the next steps would be for a young woman and how to navigate insurance issues.”

Younger women should consider that mammograms aren’t necessarily the most appropriate screening tool for them, especially if their risk profile is low or they have dense breasts, which can make spotting cancerous lesions via mammography more difficult.

Takeaway

Younger women should consider that mammograms aren’t necessarily the most appropriate screening tool for them, especially if their risk profile is low or they have dense breasts, which can make spotting cancerous lesions via mammography more difficult.

The Role of Genetic Testing

If a woman is concerned that she may have a higher risk for breast cancer given her family history, she may want to take a genetic test to see what gene mutations she carries. The most common mutations associated with breast cancer are BRCA1 and BRCA2. According to the American Cancer Society, BRCA gene mutations are more common in Jewish people of Ashkenazi descent, although they can appear in anyone.

Family history is also a factor. While most women who develop breast cancer have no family history, those who do have a family history of the disease are at higher risk. The American Cancer Society says that a woman with a first-degree relative with breast cancer, such as a mother, sister, or daughter, has a nearly twofold increased risk. If she has two first-degree relatives with breast cancer, her risk triples.

“When you have family history that meets guidelines for genetic testing, genetic testing is a good screening tool to use before ‘traditional’ mammogram age,” Melissa Gonzales, president of women’s health at Myriad Genetics, told Verywell. Women using Myriad’s genetic testing receive guidance on whether early screening or extra screening is advisable. “Genetic testing can assess your risk based on familial and personal risk factors to identify if a patient is warranted for a medical management change, such as earlier mammograms.”