Breast cancer is becoming more common among under-50s — and free screening is a secret

Around one in seven women in Australia will develop breast cancer in their lifetime.

Early diagnosis can be the difference between life and death, which is why screening programs are widely available to people who fit certain criteria.

Now, the United States Preventive Services Task Force [USPST] has recommended women there begin biennial breast screening from 40 years, down from 50.

The change recognises that more women under the age of 50 are being diagnosed with breast cancer.

It also falls in line with existing guidance from major cancer organisations in the US, which have welcomed the updated advice.

In a written statement, the American Cancer Society said it was a "critical change" for women's health and the fight against breast cancer. 

"Women in their 40s will benefit from mammography screening, and sending a strong message to referring physicians and women that breast cancer screening should begin earlier than age 50," it said. 

How do scans work in Australia? 

Australia's public mammogram screening program was launched in 1991.

It's a joint venture between the states, territories and the Commonwealth called the BreastScreen Australia Programs.

That's partly because people are only invited to get screenings between the ages of 50 and 74.

So, even though most women can get free mammograms when they turn 40, many only find out about it a decade later.

There is one caveat to the rule and it affects people who need a scan because they've developed breast cancer symptoms.

"Women who have been referred for a mammogram by their doctor may have to pay a fee," said Professor Karen Canfell, who chairs the Cancer Council's National Screening and Immunisation Committee.

"This is because they're screening outside of the program.

"While there is a Medicare rebate for mammograms, many private imaging clinics charge more than the Medicare Schedule Fee."

She credits the program with saving countless lives.

"The program has led to a significant shift in the staging of breast cancer diagnoses and is estimated in Australian research to have reduced breast cancer mortality in the screened population by between 41 and 52 per cent," she said.

Are we likely to see any changes here? 

While we are already ahead of the US in lowering the age at which women can get a mammogram, Australia's system could also see changes as soon as this year.

In late 2023, the government announced a review of the BreastScreen Australia Programs.

That review is being undertaken by an expert panel which is due to report back to the government this year.

Most medical and patient groups are aligned when it comes to the changes they want: more targeted approaches for early diagnosis of asymptomatic breast cancer.

"While BreastScreen Australia focuses on age as the most important factor for risk of breast cancer, other factors such as breast density and family history can increase risk in individual women," Professor Canfell said.

Groups including Breast Cancer Network Australia (BCNA) and the Royal Australian and New Zealand College of Radiologists have also advocated for changes to reflect modern science, including for women to be routinely told what their breast density level is.

Knowing that could help to better inform a patient on how to manage their breast health.

Why aren't women under 40 offered screening?  

Even though there's recognition women can get breast cancer when they're younger, it's still more common in older people.

"More than 75 per cent of breast cancers occur in women aged 50 to 74," said Vicki Durston, a director at BCNA. 

Another problem relates to that issue of breast density and age, which we touched on above.

A dense breast is not related to size or feel but whether a breast is made up of mostly glandular or fibrous tissue (dense) or fatty tissue (less dense).

"One of the challenges in screening younger women is breast density, which is more common in younger women," Ms Durston said.

"Breast density can reduce the ability for a mammogram to pick up cancer but can also be a risk factor for breast cancer."

The combination of age and density makes it less appealing to offer mass screening to women under the age of 40.

Instead, those women are advised to undertake regular self-examinations.

If a lump is discovered, they should see their doctor, who may refer them to a breast surgeon or to get an ultrasound.

However, any screening done at a private clinic will incur fees.

The Health Department, which oversees BreastScreen Australia, advises women aged under 50 to discuss any breast changes or family history with their GP and to decide "based on current knowledge and personal choice" if screening is appropriate to their healthcare needs.

"There is not currently sufficient evidence that women under the age of 40 years would benefit from breast cancer screening using mammography," it said in a statement to ABC. 

Finally, it is important to note that men can also develop breast cancer, although it is rare.

It accounts for around 1 per cent of cancers affecting men, according to BCNA.

It is not recommended that men get mammograms.

Instead, if they notice a breast lump, thickening of breast tissue, change in shape of the breast or nipple, swollen lymph nodes in the armpit area, or dimpling of the skin, it is recommended they speak to their GP.