As I watched the breast biopsy occurring across from me, I could not believe the woman in front of me was 26. I held her hand as she cried from the anesthesia, and I thought to myself, that could be me. She had been diagnosed with invasive ductal carcinoma of the breast a couple of months ago and was getting a lymph node biopsy. At 26, she was nowhere near the radar for national screening guidelines for breast cancer, yet she had it. In the eyes of current health policy, she was essentially invisible.
In breast radiology reading rooms, we are facing a quiet crisis. While mammography is recommended for women starting at age 40 by the U.S. Preventive Services Task Force, this still leaves a significant number of women in a diagnostic blind spot. Breast cancer in women under 40 is often more aggressive, biologically distinct, and more likely to be diagnosed at an advanced stage.
These women fall outside the standard screening age. Because of this, their concerns are frequently missed by their primary care providers and are commonly misdiagnosed as fibroadenomas. By the time they are eventually referred to a radiologist, the issue is no longer localized. There is currently a rise in triple-negative breast cancers in young women, and it is becoming a tragic public health concern.
Young women are more likely to have dense breasts, which makes standard mammography an almost inadequate diagnostic instrument in these patients. In plain terms, dense tissue appears white on a mammogram, the same color as a potential mass or asymmetry indicating an abnormality in the breast. This camouflages cancers and makes them extremely hard to detect. To find these cancers in young women, other tools like ultrasound and MRI need to be prioritized for high-risk women rather than forcing them to navigate the complicated world of insurance to receive a proper workup.
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However, mammograms for every 25-year-old are not the answer to this problem. That would lead to a high rate of false positives and callbacks that would benefit neither the patient nor the provider, unnecessarily using valuable resources while inflicting anxiety upon the patient. Overdiagnosis is also a real issue that needs to be weighed in this discussion.
A clear way to combat this is to strictly implement risk stratification by age 25. The American College of Radiology already recommends that all women, particularly Black women and those of Ashkenazi Jewish descent who are at higher risk of aggressive cancers, undergo a formal risk assessment at age 25.
If these high-risk women can be identified, we can tailor the surveillance they need before the cancer begins to grow or, worse, spread. This must be encouraged among the proper providers so women can be referred to breast radiology when needed. This accentuates the fact that in some facets of medicine, we must move away from age-based medicine and toward risk-based medicine. The women of not only Florida, but everywhere, deserve the proper screening to prevent a potential tragedy.
This essay is cited in the KevinMD record on cancer.
Isabela Henandez is a medical student.
