Milena Quiceno had a lot on her mind when she found the lump in her breast. She and her family were living in New York, which was going through lockdowns because of the coronavirus pandemic. Her office had closed in March.


Her husband worked as a grocery store supervisor, which made him an essential worker. Some of his workers died from the virus; others were in the hospital. By June, they had had enough, and they decided to leave New York to be with family in Austin.


Then he tested positive for the virus, and they had to postpone the move to Texas while the family was in quarantine. Luckily, his symptoms stayed mild with just a loss of taste and smell.


When Quiceno was still in New York, she had an ultrasound, a mammogram and a biopsy to rule out breast cancer. All the doctors and nurses thought none of the images looked bad but were waiting for results.


"It wasn’t in my mind at all," she says, when the family set out for Austin in August.


Along the way, her doctor in New York called and gave her the news that she had breast cancer. "It was a total surprise."


At 44, before she found a lump, her doctor told her during her regular visits that she didn’t need a mammogram yet.


That’s been part of the confusion for women in their 40s. Some doctors and associations say mammograms should begin at 40, while others recommend 45 or even 50.


Kimberly Ellison, a nurse practitioner at Ascension Seton Medical Center Austin, says women should make a breast care plan beginning at 25 based on their family history. If they have a family history of breast or other related cancers, mammograms should begin 10 years before the age their family member was first diagnosed.


Ellison recommends mammograms beginning at 40 for all women without a risk factor like family history of cancer. The American Cancer Society says women should have a choice of starting annual mammograms at 40, and by 45 they should be having them each year, which is a change from the recommendation of starting at age 50.


The American College of Physicians last year recommended delaying starting mammograms until 50, in part because younger women have denser tissue, which could cause unnecessary follow-up testing.


Quiceno’s doctor in New York gave her a choice when she was 40. "She let me make my own decision, and I didn’t go," she says. After all, Quiceno was doing monthly self-exams and didn’t feel anything different.


Now she wishes she had done that screening at 40.


"Sooner is better," Ellison says. Catching breast cancer early makes a difference.


Stage 1 breast cancers, which was Quiceno’s diagnosis, have about a 99% survival rate. At stage 2, which involves some lymph nodes, the survival rate is 86%, the American Cancer Society says. In later stages that involve organs, the survival rate is 27% in five years.


Locally, screening centers are taking safety measures such as mandating mask-wearing, more sanitation precautions and waiting outside for your appointment.


This month, Quiceno began chemotherapy. She will then have surgery and radiation.


"It’s going to be a trek," Ellison says.