October is Breast Cancer Awareness Month

By Dr. Amy White Jones | Family Medicine Physician and Founder of First Place Health

October is Breast Cancer Awareness Month. Everywhere we look, there are pink ribbons, fundraising campaigns, and reminders to schedule mammograms.

I’m glad we’re talking about breast cancer. I really am. But I also think we need to move beyond awareness and have a more meaningful conversation about what women need to know.

Because knowing breast cancer exists isn’t the same as knowing your risk. And having a mammogram isn’t the same as understanding what your results mean.

As a family medicine physician, I want women to feel comfortable asking questions about their bodies. I want them to understand the recommendations, know when something needs to be evaluated, and feel confident advocating for themselves.

So let’s talk about breast cancer.

Breast Cancer Doesn’t Always Start With a Lump

When most people think about breast cancer, they picture finding a lump during a breast self-exam. And yes, a new lump can be a sign of breast cancer.

But it isn’t the only one.

Breast cancer can also cause changes in the size or shape of a breast, dimpling or thickening of the skin, nipple retraction, or spontaneous nipple discharge, particularly when it’s bloody or coming from one breast.

Some breast cancers cause very few noticeable changes at all.

That’s one reason screening is so important. Mammograms can identify abnormalities before a woman feels anything unusual.

I also want to emphasize that most breast changes are not cancer. Cysts, hormonal changes, and benign breast conditions are common. But you cannot reliably determine whether a new breast lump is harmless simply by how it feels.

If you notice something new, get it checked.

And please don’t wait until your next routine mammogram to mention it. A new symptom needs a clinical evaluation, which may include diagnostic imaging rather than routine screening.

When Should You Start Getting Mammograms?

This is one of the most common questions women have, and the recommendations have changed over time.

In 2024, the U.S. Preventive Services Task Force updated its recommendation to begin screening mammograms at age 40, rather than waiting until age 50.

For women at average risk, the recommendation is a mammogram every two years from ages 40 through 74.

Other professional organizations recommend annual screening beginning at age 40, so you may hear slightly different advice depending on your physician and the organization they’re following.

I think women deserve to understand that difference.

Screening mammograms reduce the risk of dying from breast cancer, but they aren’t perfect. They can occasionally miss cancers. They can also identify abnormalities that turn out to be harmless, leading to additional imaging, biopsies, expense, and anxiety.

There is also the possibility of overdiagnosis, which means finding a cancer that would never have caused symptoms or shortened someone’s life.

These are real considerations, and discussing them doesn’t diminish the value of screening.

For most women, I want the conversation about mammograms to begin by age 40, if not earlier. Your personal and family history may change the plan.

You Can Develop Breast Cancer Without a Family History

I hear women say things like, “Breast cancer doesn’t run in my family, so I’m probably okay.”

I understand the reasoning, but family history is only one piece of the picture.

Many women who develop breast cancer do not have a first-degree relative with the disease.

Your risk is influenced by several factors, including age, inherited genetic variants, breast density, reproductive history, and certain hormonal exposures.

Some of those things we can influence. Others we cannot.

And while having a mother, sister, or daughter with breast cancer can increase your risk, family history on your father’s side counts, too.

If your family has a history of breast or ovarian cancer, particularly diagnoses at younger ages, multiple affected relatives, or male breast cancer, bring that information to your physician.

Some women benefit from formal risk assessment, genetic counseling, or a different screening schedule that includes breast MRI.

You don’t have to figure that out alone.

What Does It Mean to Have Dense Breasts?

You may have received a mammogram report saying you have dense breast tissue.

First, having dense breasts is common. It isn’t a diagnosis of cancer.

Breast density describes the proportion of fibroglandular tissue compared with fatty tissue on a mammogram.

Dense breast tissue is associated with an increased risk of breast cancer. It can also make cancers more difficult to identify on mammography because both dense tissue and many cancers appear white on the images.

This sometimes leads to questions about additional imaging, such as ultrasound or MRI.

The answer isn’t necessarily that every woman with dense breasts needs another test.

Your overall risk matters. A woman with dense breasts and a strong family history may need a different approach than someone with dense breasts and no other significant risk factors.

If your mammogram says you have dense breasts, ask your physician to help you understand your overall breast cancer risk and whether additional screening would be appropriate.

Can You Actually Lower Your Risk?

We can’t prevent every case of breast cancer. I wish we could.

But there are things we can do that are associated with a lower risk.

Alcohol is one of the more important modifiable risk factors. Even relatively modest alcohol consumption has been associated with an increased risk of breast cancer, and risk generally rises as consumption increases.

Regular physical activity is associated with a lower risk, as is avoiding excess weight gain, particularly after menopause.

Breastfeeding is also associated with a modest reduction in breast cancer risk.

None of these things guarantees that you won’t develop cancer.

And I want to be careful about how we talk about prevention, because women who develop breast cancer have not necessarily done anything wrong.

I’ve seen how easily conversations about health can become conversations about blame.

A woman can exercise, eat well, avoid alcohol, and still develop breast cancer. Another woman may have several risk factors and never develop it.

Our goal is to make informed decisions about the things within our control, not to create a false sense that every disease is preventable.

A Normal Mammogram Doesn’t Mean You Should Ignore a New Symptom

I want to spend a little time on this because it’s easy to misunderstand what a screening test tells us.

A normal mammogram is reassuring, but it does not rule out every breast cancer.

If you develop a new lump, persistent focal breast changes, spontaneous bloody nipple discharge, or a new change in the skin or nipple, you should be evaluated even if your last mammogram was normal.

Depending on your age and symptoms, your physician may recommend a diagnostic mammogram, targeted ultrasound, or additional testing.

Please don’t dismiss something simply because you had a normal screening study six months ago.

You know what is normal for your body. When something changes, it’s reasonable to ask questions.

Breast Cancer Care Has Improved, but Not Everyone Benefits Equally

There have been tremendous advances in breast cancer treatment.

Today, treatment is increasingly guided by the biology of the cancer itself. Hormone receptor status, HER2 status, stage, and other tumor characteristics help physicians determine which therapies are most likely to be effective.

Surgery, radiation, endocrine therapy, chemotherapy, targeted therapies, and immunotherapy all have roles in treating different types of breast cancer.

But access to those advances isn’t equal.

Black women in the United States have a substantially higher breast cancer mortality rate than White women, despite having a lower overall incidence of the disease. Differences in tumor biology contribute, but disparities in timely diagnosis, treatment, and access to high-quality care are also part of the problem.

Awareness alone won’t solve that.

Women need access to screening, timely follow-up when something abnormal is found, and appropriate treatment regardless of where they live or what they earn.

What I Want You to Do This October

I don’t want you to finish reading this article feeling frightened.

I want you to feel informed.

If you’re 40 or older and haven’t had a mammogram, talk with your physician about screening.

If you have a family history of breast or ovarian cancer, make sure your physician knows the details.

If you’ve received a report saying you have dense breasts, ask what that means for your personal risk.

And if you’ve noticed a change in your breast, please make an appointment to have it evaluated.

Most importantly, don’t let fear keep you from getting answers.

There are many reasons women put off medical care. We’re busy. We’re raising children, caring for parents, working, managing households, and trying to keep up with everything else life requires. Sometimes we’re simply afraid of what we might find.

I understand that.

But your health deserves a place on your calendar, too.

This October, I hope you’ll do more than wear pink. Learn your risk. Ask questions. Schedule the screening you’ve been putting off. Encourage the women you love to take care of themselves.

And remember that taking care of your health isn’t selfish.

It’s one of the ways you take care of the life you’re building.

Dr. Amy White Jones
Family Medicine Physician
Founder, First Place Health

First Place Health provides physician-led telehealth care to patients located in North Carolina. Breast symptoms and mammography require appropriate in-person evaluation and imaging. We encourage patients to establish ongoing relationships with local healthcare professionals for preventive screenings and diagnostic care.