More than one fifth of women between 35 and 44 say they have never received a mammogram and have no plans of getting one.

Breast cancer kills about 42,000 American women each year, yet only 43% know their family history of the disease and 32%, their own individual risk factors, according to researchers at Orlando Health.

In a national survey commissioned by the university, 22% of women said they did not plan on getting a mammogram and have not had one prior. The researchers say decisions like this put women at greater risk of being diagnosed with an advanced form of the disease.

“Survival goes from nearly 100 percent at stage zero to 50 to 70 percent for those diagnosed at stage two or three,” said Dr. Nikita Shah, medical oncology team leader for the Breast Care Center at the Orlando Health Cancer Institute, in a statement.

Additionally, not getting a mammogram goes against guidelines by the National Comprehensive Cancer Network, which recommends that women of average risk get an annual screening starting at age 40, and earlier if they have a family history, prior biopsies, atypical cells and dense breast tissue.

If caught early, breast is one of the few forms of cancer where the survival rate is very high. Catching it early may also prevent the need for extensive chemotherapy, radiation and surgical treatments.

Specific groups who are at greater risk of being diagnosed should be extra precautious. Black women, for instance, are more likely to be diagnosed at younger ages and have a 40% greater chance of dying from breast cancer than white women.

“African American women tend to have a more aggressive disease course, and we want everybody, regardless of their race, to be aware and get their recommended mammograms,” said Shah.

Shah and her colleagues recommend women speak with their primary care physician or gynecologist about their risks starting in their 20s. They also say that monthly self-breast exams are necessary for keeping track of any changes.

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