Nicole Seagriff was diagnosed with breast cancer at 26, more than three decades years earlier than the American Cancer Society's median age of 62.

"I got genetic testing in 2012, which found I had a BRCA2 genetic mutation. I met with a high-risk oncologist who ordered an MRI. The MRI found the cancer," Seagriff told PS in a previous interview.

"I wasn't shocked that I had a genetic risk, but I was absolutely blindsided that I had breast cancer at 26," she said. And Seagriff is not alone in this experience.

In 2024, the American Cancer Society's 2024 published a report calling out the uptick in cancer cases involving younger people. The report showed that younger adults were the only age group with an increase in cancer cases between 1995 and 2020. Understandably, this has left many wondering: "When is the right time to get a mammogram?" -- myself included. Should we be getting them sooner than the recommended age of 40?

The truth is, it depends. The breast cancer screening guidelines have fluctuated over the years, so you may be confused about when is the right time to go in for your first official mammogram. We asked experts to clear things up.

Arif Kamal, MD, MBA, is the chief patient officer for the American Cancer Society.

Stacy Smith-Foley, MD, is the medical director of the Breast Center at CARTI, an Arkansas-based cancer clinic.

"Our recommendation at the American Cancer society is for women to start considering mammograms at the age of 40 and to talk to their doctors about it," says Arif Kamal, MD, MBA, chief patient officer for the American Cancer Society. As a general practice, Dr. Kamal himself recommends them at 40 and every year after.

The United States Preventive Services Task Force (USPSTF) has slightly different guidelines, recently updated in April 2024, to recommend mammograms every other year, starting at age 40 through age 74. Either way, starting at age 40 is the general guideline.

"Lowering the age for initial screening to 40 years is critical as approximately 60,000 breast cancers are diagnosed each year in women under 50," Stacy Smith-Foley, MD, medical director of the Breast Center at CARTI, said at the time of the USPSTF changes.

"Additionally, the change helps to address disparities in breast cancer outcomes. Black women are more likely than any other group to be diagnosed with breast cancer under the age of 40 and have a 40 percent higher mortality rate compared to white women," Dr. Smith-Foley points out. "Lowering the age for initial screening helps better address the needs of this group."

Dr. Kamal hears this concern often, but doesn't believe there's a need to start screening earlier than 40 unless you have certain risk factors (more on that later).

"At the American Cancer Society, we look at our guidelines pretty frequently to find when the evidence is updated enough to suggest moving the age," he says. "And so right now, we don't see the evidence suggesting that there would be a large population benefit for doing mammograms in your 30s."

But there is a caveat, per Dr. Kamal: "It's important to recognize that guidelines are meant to reflect on a large population of people, but they're not necessarily used to guide individual decisions, particularly if people have other risk factors that are important."

"Guidelines are meant for people at average risk," Dr. Kamal says. The average lifetime risk of breast cancer for a woman in the US is about 12-13 percent, or one in eight women.

"But if a woman is at higher than average risk, then there are many considerations to take, including the age at which you start a mammogram and even what type of test to use to screen for cancer, including things like ultrasound and MRI," he continues.

So what impacts your risk, exactly? Here's a few things to consider:

All of these factors can and should be addressed in your breast cancer risk assessment, Dr. Kamal says. This is a straightforward series of questions and accompanying scoring system that doctors use to determine your breast cancer risk.

"So, starting at age 30 I'd say, come in and talk to your doctor. Share all these pieces of information. They'll know what to ask you," Dr. Kamal says. "And if the calculator says that your lifetime risk of breast cancer let's say is 20 percent or higher, instead of 12 percent, which would be the average [risk], then we might consider doing something different."

For women who are at increased risk, particularly because of family history or other exposure, your provider may consider doing mammograms not only sooner, but more frequently (e.g. twice a year instead of once a year).

Another thing to be mindful of is the type of modality being used for testing. An MRI, in addition to a mammogram, can be a more thorough testing method, says Dr. Kamal -- especially for those with higher risks. "Ultrasounds can also see things that mammograms cannot. And so it's also important for women who are worried about their risk to also inquire about other types of testing and whether that's right for them," he says.

You've probably heard the word "dense breasts" before and not really known what it meant. Before my career as a health editor, I didn't either. But I knew it could increase your chances of breast cancer.

"First of all, breast density is not something you or your partner can feel. So while the word density sounds like something is thicker, while that is kind of true, only the mammogram can really tell that," Dr. Kamal says -- and even then, things get tricky.

Here's how Dr. Kamal explains it: imagine you are driving down the highway and as you're driving, your view gets obstructed by a bunch of really thick fog, and you're worried about running into the next car in front of you, because you can't see all that well. Dense breasts on a mammogram are like the fog: "The concern is that there's cancer behind it, behind the fog, and you're not going to see it all that well." So sometimes an MRI or an ultrasound can serve as the "fog lights" that you need to detect the cancer in dense breasts (which about 40 percent of women have).

Dense breasts can also be genetic, so it can't hurt to ask your family members if there is a history of breast density and then to bring that up to your doctor during your risk assessment conversation.

While there is no cure for breast cancer, getting a mammogram is still the best tool we have for early detection -- and hopefully, prevention. But age isn't the only factor that determines whether or not you should get a mammogram. Risk factors play the biggest role. And it's never too soon to start that conversation.