Debunking Myths in Breast Cancer Screening

Despite the critical role of screening mammography for breast cancer, misconceptions persist regarding when screening should begin, how frequently it should be performed, and what younger women should know about evolving breast cancer risk. In this interview, Dr. Jasmin Hundal speaks with Dr. Alyssa Cubbison, a Breast Imaging Radiologist at the Ohio State University, about public perceptions of screening mammography and the clinical implications of persistent confusion around guideline-based care. A central theme emerged: clinicians should continue emphasizing annual mammographic screening beginning at age 40 for average-risk women, while identifying higher-risk patients early through formal risk assessment.

Public Perception vs Clinical Recommendations 

Dr. Cubbison began by discussing Ohio State’s recent national survey, which was designed to better understand how women perceive mammography recommendations. The survey aimed to assess public perception regarding when women should start screening mammograms and at what time interval they should begin. The most notable finding was that many women still believe screening should start later, with 44% of women acknowledging that they thought screening mammograms should begin at age 50 instead of at age 40.

For clinicians, this gap matters. Dr. Cubbison emphasized her own practice standard clearly: “we strongly recommend that average-risk women starting at the age of 40 should get their screening mammogram every year.” She also highlighted the importance of earlier-risk conversations, adding beginning around age 25, women should discuss breast cancer risk with their provider so that those at elevated risk can begin surveillance earlier if needed.

Younger-Onset Breast Cancer and Risk Awareness

Dr. Cubbison also addressed the increasing incidence of breast cancer in younger women: “we do know, based on CDC data, that there is a small but real rise in breast cancer under the age of 45.” For oncology clinicians, this reinforces the need for proactive counseling, particularly when patients encounter conflicting age thresholds in public messaging.

Although Dr. Cubbison did not suggest a wholesale change in screening recommendations for average-risk women, she strongly connected current guidance to this epidemiologic trend. This reality strengthens the case for consistent clinician messaging around annual screening at 40 rather than delayed initiation.

Common Myths That Still Influence Patients

Dr. Cubbison described a frequent patient statement: “Well, I didn't come in for my screening because there's no breast cancer in my family.” She cautioned clinicians to actively correct this assumption, noting that “most women diagnosed with breast cancer have no attributable family risk of breast cancer; about 75% have no family history.”

She also addressed substitution of MRI for mammography. Patients may say they want to “forego the mammogram in lieu of an MRI since it has no radiation.” But she clarified that MRI should not replace mammography in routine practice: “There are things that the MRI will miss that will be declared on a mammogram.” Further, MRI can increase unnecessary workup through false positives, making combined, guideline-concordant imaging more appropriate when indicated. 

Practical Guidance for Women Under 40

For women not yet eligible for routine screening, Dr. Cubbison recommended familiarity with baseline breast findings and prompt evaluation of concerning symptoms. She advised patients to understand “the baseline of how your breast feels” so they can recognize change. She also stressed that “if you do feel a lump, that's something that we definitely want you to get evaluated,” and that symptoms such as nipple discharge warrant assessment regardless of age. 

For high-risk patients, individualized earlier screening remains essential. Dr. Cubbison noted that for women who have a first-degree relative with a history of breast cancer, it is recommended to start getting screening mammogram 10 years prior to the relative’s age at diagnosis. She concluded, “I’d like to reiterate that we recommend starting screening for women at average risk at age 40, every year.”

Key Takeaways

• Reinforce annual screening mammography beginning at age 40 for average-risk women.

• Address persistent patient misconceptions, especially that absent family history means screening is unnecessary.

• Remind patients that MRI does not replace mammography and may miss findings seen on mammogram.

• Encourage formal breast cancer risk assessment around age 25 to identify high-risk women early.

• Promptly evaluate symptoms such as a new lump, bloody nipple discharge, or persistent focal breast pain.

• Use consistent, evidence-based messaging, particularly given the small but notable risk in breast cancer under age 45.

About the Speakers

Alyssa Cubbison, DO, is a Breast Imaging Radiologist at The Ohio State University Comprehensive Cancer Center. She specializes in the detection of breast cancer through digital mammography, tomosynthesis, breast ultrasound, MRI, and image-guided breast biopsies and localization procedures. Dr. Cubbison is passionate about utilizing the most up-to-date technology and collaborating with clinical colleagues to provide individualized care for each patient. 

Jasmin Hundal, MD, MS, MPH, is a third-year Hematology/Oncology Fellow at the Cleveland Clinic in Cleveland, Ohio. Previously, she completed her Internal Medicine Residency at the University of Connecticut. Dr. Hundal’s main area of interest is the overlap between cardiometabolic health and cancer, particularly for breast cancer patients and survivors. Outside of work, she enjoys traveling, cooking, and hiking.