That's a really good question, because we know that family doctors are provided with a decision tool that understates the benefits and exaggerates the harms. It's almost designed to discourage women from having screening.
My advice would be to go have your mammogram at age 40. Yes, it's going to be a little uncomfortable. Don't book the test for when you're premenstrual, because that's when breasts are the most tender. Let's make it the best we can for your first time. Maybe even take a Tylenol an hour before the test. That'll give you some very important information right off the bat. You'll find out whether you have dense breasts, and hopefully you'll get an all-clear.
Another important piece of advice I would give women is that when you get that report and it tells you your breast density, if you're category C or D, which means you have dense breasts, you should, at the very least, do breast self-examination, because we know mammograms can miss cancers and we want women to find them as early as possible. If at all possible, try to get a supplemental test like ultrasound if you're at average risk. If you're at very high risk, have an MRI. Go online and look at the IBIS risk assessment tool. It's just a few questions, and it will tell you what your lifetime risk and risk over the next 10 years are of getting breast cancer. If you have higher than a 20% or 25% lifetime risk, you're at high risk, and you should be talking to your doctor about getting referred to a high-risk screening program.
All women should have a risk assessment by about age 30, and women should be encouraged to do breast self-examination so they get to know what their normal is and have a better chance of finding cancer as early as possible.
Thank you.