Your healthcare provider may not be aware that the decision to screen at 40 is a woman's decision based on her values and preferences, as stated in the breast screening guidelines made for health care providers. Yes, it is your choice.

No woman in Canada should be denied a requisition. If you live in a province where you cannot self-refer at 40, it is your decision to have a mammogram in your 40s. That's also what the breast screening guidelines state. Your choice. It is highly recommended by experts to do so since 17% of breast cancers happen in the 40s and these cancers are more fuelled by hormones and thus more aggressive.

If you live in a province where you still need a requisition at 40 (AB, SK, QC, MB, NWT) then please check out the conversation tips for speaking with your health care provider about a mammogram starting at 40 in our Advocacy Toolkit.

Since most jurisdictions in Canada only allow self-referral for breast screening starting at 40 or 45, what can you do to be proactive about your breast health in your 20s and 30s?

1. Know your risk factors. Discuss your risk with your family doctor between ages 25-30.
According to the Canadian Society of Breast Imaging, a woman’s risk for getting breast cancer should be assessed by her health care  provider by age 25-30 to determine if early screening is appropriate.  About 4% of invasive breast cancers were diagnosed in women in Canada under age 40 in 2019.

Do you have personal risk for breast cancer, such as family history of breast cancer? If you have a first degree relative who had breast cancer in the 40s, it may be recommended that you begin screening ten years earlier. If you have a family history of genetic mutations, or history of lymphoma, you may be eligible for a provincial high risk program in which screening would begin earlier. There are many different risk scenarios so please have a discussion with you provider since women with a higher risk may need to start screening earlier than 40. Consider completing the IBIS risk calculator https://ibis.ikonopedia.com/ with your physician and discuss if there is a need for a personalized screening plan.

2. Be breast aware: Regularly perform self-exams to become familiar with how your breasts normally look and feel. Check out www.knowyourlemons.com for examples of breast cancer symptoms and clear instructions on how to perform a breast self-exam. See your health care provider about any unusual changes to your breasts. Insist on imaging for any symptom of breast cancer.

3. Make healthy lifestyle choices: Maintain a healthy lifestyle by staying active and eating a balanced diet. Avoid alcohol and smoking, which are both carcinogenic. These steps can reduce your overall cancer risk. It is estimated that ~50% of breast cancers can be prevented.

4. Advocate for yourself:  Self-advocacy is important in this age group. If your circumstances/history indicate you need screening before 40, advocate for yourself. If you have a symptom, you may hear you are too young for it to be breast cancer. Only imaging can determine if the symptom is of concern. Do not be dismissed. Seek care elsewhere if needed. No healthcare provider has X-ray vision. You are your own best advocate.