Today Show contributor Jill Martin announced her breast cancer diagnosis. Martin’s announcement was heartbreaking…and for many women around the world, a terrifying wake-up call. 

Martin revealed that she had a normal mammogram in January and that her own mother (who has a personal history of breast cancer) had tested negative for the BRCA gene mutation (which substantially increases a person’s risk of cancer). Despite these reassurances, Martin was advised to get tested for the genetic mutation herself. Surprisingly, Martin tested positive and chose to have preventative surgery to reduce her risk of getting cancer. 

But while undergoing scans ahead of her surgery, doctors detected breast cancer — just months after her mammogram came back clear.

“Mammograms do save lives, and they are still the number one way to detect breast cancer — but no test is perfect, and mammograms certainly aren’t. They pick up about 85 to 90 percent of cancers,” says Martin’s physician, Elisa Port, MD during an appearance alongside Martin. 

Martin’s story is a sobering reality check: Even when people follow all the guidelines and stay on top of their screenings, things can fall through the cracks. Take, for example, Leanne Hainsby, the Peloton instructor who was diagnosed with breast cancer at just 35 — a full five years before experts recommend women of average risk for breast cancer begin getting mammograms.

That doesn’t mean we should lose faith in breast cancer screening — and it certainly doesn’t mean we should forgo recommended mammograms. But it does underscore the importance of listening to your body, checking for lumps in your breasts at home, finding a doctor who really pays attention, and advocating for yourself

Here, John M. Koval, M.D. a physician with Tampa Bay Radiation Oncology, breaks down everything people need to know about how to approach and individualize breast cancer screening guidelines.

This is when women should start getting regular mammograms

“Breast cancer screenings should be done every other year starting at age 40, for women at average risk, according to draft guidance issued in May by the U.S. Preventive Services Task Force, an independent panel of national experts,” says Dr. Koval.

With that being said, significant risk factors change when you should start being screened.

According to Dr. Koval, women with certain risk factors, including a family history of breast cancer (especially in close relatives like mother or sister), a personal history of breast cancer, having a BRCA gene mutation, previous exposure to chest radiation therapy, and certain benign breast conditions should start getting mammograms sooner than age 40.

You can discuss your personal case and risk factors with your physician to determine the best time for you to begin screening.

If you want regular mammograms before 40, here’s what you can do

I’ve been getting regular mammograms since I found a benign lump while nursing my daughter — I was 31 at the time, but my OB and I agreed that I should continue getting screened every year due to personal risk factors. I’ve certainly faced resistance when getting my annual mammogram, though — and I’ve been questioned pretty hard each time I’ve scheduled or attended my appointment.

But self-advocacy matters: As we’ve seen, women under 40 can certainly get breast cancer. If you feel like you need to start getting screened before you hit that age milestone, you’re well within your rights to speak up and voice your concerns. 

If you have specific concerns, a family history of breast cancer, or other risk factors, you can certainly advocate for screening before age 40. “Open communication [between patient and physician] can lead to shared decision-making and personalized screening recommendations,” says Dr. Koval.

Medical screenings are essential — but at-home screenings are key, too

 “Feeling lumps at home is an essential part of breast health awareness,” says Dr. Koval. “Women should perform breast self-exams regularly, ideally once a month, starting in their 20s. By doing so, they become familiar with their breast tissue, making it easier to detect any changes or abnormalities.”

“Feel it on the first” is a movement to encourage women to conduct self-exams on the first of every month, and it’s a movement we are huge fans of — you can keep yourself on track to feel for lumps every single month (and in order to advocate for self-screening among other women, you can post about this with the hashtag #FeelItOnTheFirst).

If you do feel a lump, know it doesn’t necessarily mean you have cancer — but take action immediately.

If you feel a lump, here’s what you can do

“If someone feels a lump during a breast self-exam, the next step is to promptly consult with a healthcare provider,” says Dr. Koval. “The healthcare provider will likely perform a clinical breast examination and may recommend further tests, such as mammograms, ultrasounds, or biopsies, to determine the nature of the lump.”

Screening may look different at this point

A mammogram is the typical test administered for routine breast cancer screening. But for someone who has discovered a lump, diagnostic screening is probably in order.

“Diagnostic screenings, on the other hand, are more comprehensive evaluations used when there is a specific concern, such as a palpable lump or other breast-related symptoms,” says Dr. Koval. “Diagnostic screenings may include additional imaging techniques and tests beyond a routine mammogram.”

Breast ultrasounds are also commonly used to detect breast abnormalities

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“Mammograms and breast ultrasounds serve different purposes. Mammograms use low-dose X-rays to detect breast abnormalities, making them effective for screening,” says Dr. Koval. “Breast ultrasounds use sound waves to create images and are often used as a supplemental test to further evaluate abnormalities found on a mammogram or to differentiate between solid masses and fluid-filled cysts.”

For women with dense breasts, mammograms may not be enough

If you’ve been told you have dense breasts, you may be better off with additional screening, as mammograms may be less sensitive at detecting abnormalities in dense breasts, according to Dr. Koval.

Some healthcare providers will recommend an ultrasound or MRI (in addition to a mammogram) for these patients.

Should you get tested for the BRCA gene mutation?

That depends on your family and personal history. “Women who have certain risk factors, such as a significant family history of breast cancer or a personal history of breast cancer, may benefit from testing for the BRCA gene mutations,” says Dr. Koval. “The BRCA gene test can help identify those at higher risk and inform appropriate risk-reduction strategies.”

These risk-reduction strategies can include a preventive mastectomy.

Here's why this all matters so much

Early detection saves lives. Plain and simple. The best way to catch breast cancer early is to stay on top of the recommended screening schedule…and as we’re learning, self-screening and self-advocacy really matter too.

According to Dr. Koval, the biggest mistake people make in regards to breast cancer screenings is not following the recommended guidelines — after all, they exist for a reason. And following these guidelines could, quite literally, separate life from death.

“Regular mammograms and breast self-exams can significantly improve the chances of early detection and successful treatment,” says the expert. “Early detection is crucial because it can lead to more effective treatment options and better overall outcomes. When breast cancer is detected at an early stage, before it has spread to nearby lymph nodes or distant organs, the chances of successful treatment and survival are higher.” 

Zara Hanawalt is a freelance journalist and mom of twins. She's written for outlets like Parents, Marie Claire, Elle, Cosmopolitan, Motherly, and many others. In her (admittedly limited!) free time, she enjoys cooking, reading, trying new restaurants, and traveling with her family.