When Trish Michelle first told her doctor about a lump in her breast at age 37, his response was that it “didn’t exist,” she tells SELF. In his view, there was little reason to be suspicious: Her prior appointments had been uneventful, she had no known family history of breast cancer, and of course, there was her age: young. “I had to put my hand over his and say, ‘How are you missing this seemingly giant boulder that has grinded my life to a halt?’” says Michelle, who is now the chief community officer at breast and gynecologic cancer nonprofit The Breasties. After considerable back-and-forth, he begrudgingly agreed to send her for a mammogram. Within three weeks, she was diagnosed with breast cancer: stage 3 invasive ductal carcinoma.
Michelle’s case is far from singular. Cancer rates in women under 50 have jumped up by nearly 20% since the early 2000s, according to a 2025 report from the American Cancer Society (ACS), and much of that spike comes from a rise in breast cancer. During the most recent decade of data (2012 to 2021), rates of breast cancer rose more steeply in this group: up 1.4% per year versus 0.7% in women older than 50. Research suggests a few potential culprits, including environmental elements (like endocrine-disrupting chemicals used in products and packaging) and lifestyle factors, like broad trends toward being more sedentary and delaying having kids.
That means a growing number of young women may be at high risk of breast cancer, even without having a noticeable symptom like Michelle’s. This is the same demo largely not captured by breast cancer screening guidelines, which start at age 40—and dictate both access and insurance coverage. But, critically, “like any other screening recommendations, these just apply to people at average risk,” Arif Kamal, MD, MBA, chief patient officer at ACS, tells SELF. And, he says, falling outside of that bucket could make you a candidate for sooner screenings, helping to ensure you catch any evidence of breast cancer STAT—or better yet, avoid it outright.
Why you should figure out your personal breast cancer risk before age 40
Carrying a high risk for breast cancer at a young age could warrant earlier, more frequent, and even different kinds of screening than the usual (which, per the United States Preventive Services Task Force (USPSTF), is a biannual mammogram starting at age 40). The ACS, for instance, suggests people in this camp get both a yearly mammogram and breast MRI starting at age 30; the latter uses a type of imaging that might better pick up some cancers in young people, who are more likely to have dense breasts. And depending on your personal situation, your doctor might also suggest screening even sooner, at a different cadence, or with other technology (like ultrasound).
Jumping on early screenings is critical if you’re at high risk for a few reasons: Research suggests young people are more likely to experience diagnostic delays for breast cancer, and they also tend to have “more aggressive forms of it, which often means larger tumor size or more advanced cancer stage when they get diagnosed,” Amy K. Patel, MD, a breast radiologist and medical director of the Breast Care Center at Liberty Hospital, in Kansas City, tells SELF. It’s a perfect storm that helps explain why women under 40 who get breast cancer are nearly 40% more likely to die from it than their older counterparts.
These concerns led the American College of Radiology (ACR) to release new guidelines in 2023 recommending all women, particularly Black women and women of Ashkenazi Jewish heritage (who are uniquely at risk), take a breast cancer risk assessment by age 25 to calculate their lifetime likelihood of developing the disease. On average, that’s a one in eight chance, or about 13% risk; greater than 20% qualifies as high. Though there are versions of these tests you can DIY—like the one Olivia Munn credits with saving her life, the Breast Cancer Risk Assessment Tool (BCRAT)—they’re designed to be given by a health care provider for accuracy. So it’s wise to ask for one at your next ob-gyn or primary care visit, if you’re 25 or older. In the meantime, read on to learn the most common risk factors that these tests take into consideration for women under 40.
Five risk factors that may warrant a breast cancer screening under age 40
1. You have a relative who’s had breast cancer or a related type of cancer.
“Time and time again, I have seen women who’ve gone to their clinician and said, ‘My mother had breast cancer,’ only to be told, ‘You don’t have to have a mammogram until you’re 40,’” Elise Desperito, MD, a radiologist and director of breast imaging at the Memorial Sloan Kettering Ralph Lauren Center, in New York, tells SELF. But the reality is, a close family history, in and of itself, can put you at high risk and warrant early screening.
“If there is a first-degree relative—meaning, a mom or sister—who had breast cancer, we absolutely want to start imaging them 10 years before their family member was diagnosed,” Dr. Desperito says. So that means, for example, if your mom got breast cancer at 39, you’d be recommended for screening at 29.
Keep in mind, only 5% to 10% of breast cancers are hereditary. But having a close family history does make it more likely that you’ve inherited a gene mutation, for instance to BRCA1 or BRCA2 (which are especially common among people of Ashkenazi Jewish heritage), that ups your susceptibility. So in this case, your doctor may also refer you for genetic counseling.
More broadly, it’s worth learning whether anyone in your immediate family (not just parents and sibs but grandparents, aunts, and uncles) has had cancer, as well as the type and when in their life it was diagnosed, Dr. Kamal says. Why? Certain other kinds—like ovarian, endometrial, and even pancreatic, stomach, and melanoma—can share genetic underpinnings with breast cancer, so having these in your bloodline could up your risk. And especially if they were diagnosed young, as early-in-life cases are more likely to have a genetic component to them, Dr. Kamal says. Bringing the whole shebang of cancer history to your doctor will help ensure they get the full picture.
2. You got your first period before age 12.
One factor that might be contributing to the spike in early-onset breast cancer is a drop in the average age when menstruation begins: It’s gone down from 12.5 in the 1950s to 11.9 in the early 2000s, and research suggests for each year younger than 12 that you start menstruating, your breast cancer risk increases by 5% to 9%. The reason is hormonal: The earlier you start your period, the more exposure you get to estrogen over time, Dr. Patel says, and some types of breast cancer rely on estrogen to proliferate.
To be clear, estrogen is an essential hormone both for reproductive health and also the strength of your bones, heart, and brain. But having it circulating in your body for longer also means more opportunity for it to boost the growth of estrogen-sensitive tumors.
3. You had your first kid over the age of 35.
While pregnancy at any age sparks a host of rapid breast changes that may temporarily up your cancer risk in the few years immediately following, facing those fluctuations at age 35-plus—when your baseline susceptibility is higher simply because of age—just further raises that risk.
Also, after you pass that postpartum zone of higher risk, pregnancy and breastfeeding are thought to offer long-term protection against breast cancer, 20 or so years after giving birth, by maturing certain breast cells and cutting down on your lifetime exposure to estrogen (you don’t menstruate while pregnant nor typically while nursing). But research suggests, if you’re over 35 when you first give birth, the initial spike in risk shakes out to be greater than the benefit you might’ve otherwise received down the line. Hence why later age of first pregnancy is a key breast cancer risk factor. (And ICYWW, never giving birth does shield you from the short-term pregnancy-related risk, but it also prevents you from reaping the longer-term benefit—which is something to consider as you assess your risk over time.)
4. You have a high body weight.
Though having a high weight is not always a health risk factor—the relationship between weight and health is nuanced—it has been linked with greater risk of 13 types of cancer, breast included. It’s thought that this has to do with how fat cells might trigger inflammation, as well as lead to a surplus of hormones like insulin (which may spur tumor growth) and estrogen. But it’s important to note: The connection between high weight and breast cancer risk, specifically, is only significant after menopause—when, experts theorize, women may be more sensitive to fat’s estrogen-boosting effect.
And yet, all the experts SELF spoke with for this story still suggest considering high weight as a potential risk factor for breast cancer even at a young age. Rather than homing in on a number on the scale, focus on healthy lifestyle habits, which may (or may not!) lower your size but will definitely decrease your cancer risk. Two great places to start are moving your body on the reg and cutting your alcohol intake, ideally to zero—the ACS cites physical inactivity and alcohol consumption as possible drivers behind the rise in breast cancer among young folks, as they account for 7% and 16% of breast cancers, respectively.
5. You are a Black woman.
Much of the racial disparity in breast cancer has to do with mortality: Black women are substantially more likely to die from the disease than white women, despite having overall similar incidence—a trend experts attribute largely to inequities in access to and quality of care that spring from systemic racism. (Michelle, for one, suspects her race was part of the reason she wasn’t taken seriously at that first appointment.) But in young Black people, the rate of breast cancer is higher too. According to one 2024 study, if you’re a Black woman between the ages of 20 and 29, you have a 53% higher risk of breast cancer than a white woman of the same age; and if you’re 30 to 39, that extra risk is 15%.
As for why? Research suggests Black women are disproportionately affected by the aggressive triple-negative kind of breast cancer—which more commonly occurs at an early age—potentially because of biological or genetic factors, or even changes to DNA caused by the unique burden of chronic stress they face. Plus, Black people may be more susceptible to some of the other risk factors on this list, like earlier periods and high weight, largely again because of the detrimental impact of structural racism on health outcomes.
Also, take note: The above isn’t a definitive list. Less common factors that can up your risk for breast cancer at a young age—and may warrant early screening—include living with certain conditions that involve a gene mutation (like Li-Fraumeni syndrome or Cowden syndrome), having had radiation therapy to your chest (for instance, to treat Hodgkin’s lymphoma), and having certain benign breast conditions. So to be sure you’re covering your bases, it’s best to get formally risk-assessed by a doctor, Dr. Patel says.
Seek care for any sign of breast cancer—regardless of your risk or age.
Anything that feels or looks out of the ordinary on or around your breasts—that could be a lump, but also dimpling, orange-peel-like texture, nipple discharge, or pain—is also a reason to see your doctor, particularly if it’s not a cyclical change, like sore breasts around your period. That applies especially if you’re under 40 because you may not have any other opportunity to get that symptom investigated, for instance at a screening. (Worth noting: Experts no longer recommend routine breast self-exams but emphasize knowing your normal so you can spot any shifts.) The overall risk of it turning out to be a cancer is very low in young people; most often, these are benign cysts or growths called fibroadenomas, Dr. Desperito says. But, “you need some kind of imaging to be 100% sure.”
With growing awareness of the rise in early-onset breast cancer, doctors may be more open to ordering scans for symptoms in young folks where they might’ve previously skipped them as a result of the patient’s age. But if you run up against resistance, Michelle has a tip for what to say in response: “I would like you to chart that.” Chances are, your doctor won’t want to risk putting on the record that you had a symptom and they denied imaging, “and they’re more likely to reverse course,” she says. And if not? It’s important to trust your gut and scout out a doctor who will do so too. “What we’re finding is, women’s intuition about something being off is, frankly, really important data,” Dr. Kamal says.
A note on insurance coverage
It can be tricky to get coverage for breast cancer screening under age 40, given that the federal requirements for coverage of preventive services track with USPSTF recommendations (which start at 40). That said, a handful of state laws (like in New York, Massachusetts, Missouri, and Colorado) do mandate coverage of “supplemental” screenings for high-risk people—like breast MRIs and ultrasounds—often regardless of age, Usha Ranji, associate director for women’s health policy at nonprofit KFF, tells SELF. This typically hinges on your doctor demonstrating to your insurance provider that your lifetime risk is 20% or greater, Dr. Desperito explains, as shown by a risk assessment.
Outside of these imaging-friendly states, you may still be able to get some coverage for early screening on a case-by-case basis, Ranji says: As with any service, your doctor can submit a request to your insurance company with info on why they deem it medically necessary, and your insurer may approve it—it just will likely be subject to the coinsurance that applies to other services in your plan (versus fully free). They’re also likely to approve imaging that is diagnostic in nature, Dr. Kamal says, meaning a test to check out a concerning symptom.
So it’s certainly worth advocating for imaging before age 40 if you suspect you’re at high risk or something’s off with one of your breasts—after all, the downside of a scan that turns out to be unnecessary is “very, very little,” Dr. Kamal says. And the upside can be immense: Thanks to Michelle’s insistence on getting a mammogram, her cancer was caught while still treatable, and she just surpassed nine years cancer-free. It’s been far from easy, she says, describing her course through chemotherapy, radiation, and a double mastectomy. “But it was also a lesson on just how important it was for me to have a voice.”
Related:
- I Was Diagnosed With Breast Cancer at 36. Here’s How I Caught It Early
- 9 Things No One Tells You About Having Breast Cancer
- Yes, Breast Cancer Can Hurt—Here’s Why Doctors Want to Put This Myth to Rest
Get more of SELF’s great service journalism delivered right to your inbox.
