Breast Cancer Screening for Women at Higher Risk

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Routine breast cancer screening is important for all women, but even more so for those at higher than average risk. If you’re at higher risk of breast cancer, you may need to be screened earlier and more often than other women.

You’re considered at higher risk if you have one factor that greatly increases risk or several factors that together, greatly increase risk.

Your health care provider may use different tools to assess your risk and help you make a personalized breast cancer screening plan.

Learn more about breast cancer risk.

Women at higher risk of breast cancer

Factors that greatly increase breast cancer risk include [3]:

Figure 3.5 below outlines the National Comprehensive Cancer Network (NCCN) breast cancer screening guidelines for women at higher than average risk up to age 75.

The NCCN recommends women older than 75 talk with their health care providers about a breast cancer screening plan that’s right for them. 

Figure 3.6 below outlines the American Cancer Society (ACS) breast cancer screening guidelines for women at higher than average risk (these differ somewhat from the NCCN guidelines).

Figure 3.5: NCCN breast cancer screening recommendations for women at higher than average risk

Risk factor

Clinical breast exam

Mammogram*

Breast MRI

Lobular carcinoma in situ (LCIS)

Every 6-12 months

Every year starting at age 30

Talk with your health care provider about breast MRI every year starting at age 25

Atypical hyperplasia and a greater than 20 percent lifetime risk of invasive breast cancer

(Estimate your lifetime risk or learn more about risk.)

Every 6-12 months

Every year starting at age 30

Talk with your health care provider about breast MRI every year starting at age 25

BRCA1 or BRCA2 gene mutation

Ages 25-29

Every 6-12 months

Only if breast MRI not available:
Every year

Every year
(if breast MRI not available, then mammogram)

Ages 30 and older 

Every 6-12 months

Every year

Every year

A first-degree relative with a BRCA1/2 gene mutation, but not tested for BRCA1/2 gene mutations themselves

Every 6-12 months

Every year starting at age 30

Talk with your health care provider about genetic testing before getting MRI as part of screening

Radiation treatment to the chest between ages 10-30

Under age 25

Every year starting 10 years after radiation treatment

Not recommended

Not recommended

Ages 25-29

Every 6-12 months starting 10 years after radiation treatment

Not recommended

Not recommended

Ages 30-75

Every 6-12 months starting 10 years after radiation treatment

Every year starting 10 years after radiation treatment

Every year starting 10 years after radiation treatment

Li-Fraumeni syndrome 

or

TP53 gene mutation 

Ages 20-29

Every 6-12 months starting at age 20 or at the age of the youngest breast cancer case in the family (whichever comes first)

Only if breast MRI not available:
Every year

Every year
(if breast MRI not available, then mammogram)

Ages 30 and older

Every 6-12 months

Every year

Every year

Cowden/PTEN syndrome or Bannayan-Riley-Ruvalcaba syndrome 

or

a PTEN gene mutation

Every 6-12 months starting at age 25, or 5-10 years before the age of the youngest breast cancer case in the family (whichever comes first)

Every year starting at age 30-35, or 5-10 years before the age of the youngest breast cancer case in the family (whichever comes first)

Every year starting at age 30-35, or 5-10 years before the age of the youngest breast cancer case in the family (whichever comes first)

An ATM, CHEK2 or NBN gene mutation

Every 1-3 years ages 25-39

Every year starting at age 40

Every year starting at age 40

Talk with your health care provider about breast MRI every year starting at age 40

CDH1 gene mutation

Every 1-3 years ages 25-39

Every year starting at age 40

Every year starting at age 30

Talk with your health care provider about breast MRI every year starting at age 30

An NF1 gene mutation

Every 1-3 years ages 25-39

Every year starting at age 40

Every year starting at age 30

Talk with your health care provider about breast MRI every year ages 30-50

PALB2 gene mutation

Every 1-3 years ages 25-39

Every year starting at age 40

Every year starting at age 30

Every year starting at age 30

An STK11 gene mutation

Every 1-3 years ages 25-39

Every year starting at age 40

Every year starting at age 40

Not recommended

Personal history of breast cancer (including DCIS), but no suggested family history of breast, ovarian or certain other cancers

1-4 times a year for the first 5 years after treatment ends

Every year starting year 6

Every year

Not recommended

Dense breast tissue

Every 1-3 years ages 25-39

Every year starting at age 40

Every year starting at age 40

Talk with your health care provider

Atypical hyperplasia with a 20 percent or less lifetime risk of invasive breast cancer

(Estimate your lifetime risk or learn more about risk.)

Every 1-3 years ages 25-39

Every year starting at age 40

Every year starting at age 40

Talk with your health care provider

Estimated risk 

Clinical breast exam

Mammogram

Breast MRI

Women ages 35 and older with a 5-year risk of invasive breast cancer of 1.7 percent or higher

(Estimate your 5-year risk or learn more about risk.)

Every 6-12 months starting at age found to be at increased risk by Gail Model

Every year starting at age found to be at increased risk by Gail Model

Not recommended

Women at greater than 20 percent lifetime risk of invasive breast cancer based mainly on family history

(Estimate your lifetime risk or learn more about risk.)

Every 6-12 months starting at age found to be at increased risk

Every year starting 10 years younger than the youngest breast cancer case in the family (but not before age 30)

Every year starting 10 years younger than the youngest breast cancer case in the family (but not before age 25)

If you have a first-degree relative with a BRCA1/2 gene mutation, you’re encouraged to talk with your health care provider about genetic testing before getting MRI as part of screening (for those who don’t wish to have genetic testing, MRI is recommended)

* 3D mammography (breast tomosynthesis) may be considered.

Adapted from NCCN materials [3,59-60].

 

Figure 3.6: ACS breast cancer screening recommendations for women at higher than average risk

Risk factor

Clinical breast exam

Mammogram

Breast MRI

Lobular carcinoma in situ (LCIS)

Not recommended

Every year

Talk with your health care provider

Atypical hyperplasia 

Not recommended

Every year

Talk with your health care provider

BRCA1 or BRCA2 gene mutation

or

a first-degree relative with a BRCA1/2 gene mutation, but not tested for BRCA1/2 gene mutations themselves

Not recommended

Every year starting at age 30 or age recommended by health care provider

Every year starting at age 30 or age recommended by health care provider

Radiation treatment to the chest between ages 10-30

Not recommended

Every year starting at age 30 or age recommended by health care provider

Every year starting at age 30 or age recommended by health care provider

Li-Fraumeni syndrome, Cowden/PTEN syndrome or Bannayan-Riley-Ruvalcaba syndrome

or

a first-degree relative with one of these syndromes

Not recommended

Every year starting at age 30 or age recommended by health care provider

Every year starting at age 30 or age recommended by health care provider

Personal history of breast cancer (including DCIS)

Not recommended

Every year

Talk with your health care provider

Dense breast tissue

Not recommended

Every year

Talk with your health care provider

Estimated risk

Clinical breast exam

Mammogram

Breast MRI

Women at about 20-25 percent or greater lifetime risk of invasive breast cancer based mainly on family history

(Estimate your lifetime risk or learn more about risk.)

Not recommended

Every year starting at age 30 or age recommended by health care provider

Every year starting at age 30 or age recommended by health care provider

Adapted from ACS materials [4].

 

Women Should Have Access to and Coverage for Mammography

Susan G. Komen® believes all women should have access to regular screening mammograms when they and their health care providers decide it is best based on their personal risk of breast cancer. In addition, screening should be covered by insurance companies, government programs and other third-party payers. Read more.

 

Breast magnetic resonance imaging (MRI)

What is breast MRI?

Breast magnetic resonance imaging (MRI) uses magnetic fields to create an image of the breast.

Breast MRI is more invasive than mammography because a contrast agent is given by vein (through an IV) before the test.

Breast MRI is sometimes used in breast cancer diagnosis and staging.

Breast MRI and breast cancer screening

Breast MRI is not routinely used in breast cancer screening for most women. There are some downsides to breast MRI.

Breast MRI in combination with mammography is better than mammography alone at finding breast cancer in certain women at higher than average risk [61-64].

The NCCN recommends screening with mammography plus breast MRI for some women at higher risk of breast cancer, including those with [3,59]:

  • A BRCA1 or BRCA2 gene mutation
  • A first-degree relative with a BRCA1/2 gene mutation, but have not been tested for BRCA1/2 mutations themselves
  • Radiation treatment to the chest area between ages 10-30
  • Li-Fraumeni, Cowden/PTEN syndrome or Bannayan-Riley-Ruvalcaba syndrome (and first-degree relatives)
  • PALB2, PTEN or TP53 gene mutation
  • A greater than 20 percent lifetime risk of invasive breast cancer based mainly on family history (Estimate your lifetime risk or learn more about risk.)

The NCCN recommends women with an ATM, CDH1, CHEK2, NBN or NF1 gene mutation, consider breast MRI as part of their breast cancer screening [59].

Women at higher risk who are recommended breast MRI as part of breast cancer screening, but cannot have one for medical reasons, may consider breast ultrasound [3].

Talk with your provider about breast cancer screening. Together, you can make a screening plan that’s right for you.

Learn about emerging research on breast cancer screening with breast MRI plus mammography in women at higher than average risk.

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For a summary of research studies on breast MRI plus mammography versus mammography alone for women at higher than average risk of breast cancer, visit the Breast Cancer Research Studies section

Timing of breast MRI screening

  • For premenopausal women, the best timing for breast MRI is days 7-15 of your menstrual cycle [3].
  • For postmenopausal women, breast MRI can be done at any time.
  • For high-risk patients getting both mammography and breast MRI every year for screening, your health care provider may stagger the tests so you get one test every 6 months.

Insurance coverage of breast MRI screening

Insurance coverage for breast MRI screening varies. You may want to check with your insurance company before getting a breast MRI for screening to see if it’s covered.

Learn about breast MRI screening for women at average risk of breast cancer.

Learn more about BRCA1 and BRCA2 gene mutations.

 

  

 SUSAN G. KOMEN® SUPPORT RESOURCES 

  • If you or a loved one needs more information about breast health or breast cancer, call the Komen Breast Care Helpline at 1-877 GO KOMEN (1-877-465-6636). All calls are answered by a trained specialist or oncology social worker in English and Spanish, Monday through Friday from 9:00 a.m. to 10:00 p.m. ET. You can also email the helpline at helpline@komen.org
  • We offer an online support community through our closed Facebook Group – Komen Breast Cancer group. The Facebook group provides a place where those with a connection to breast cancer can discuss each other’s experiences and build strong relationships to provide support to each other. Visit Facebook and search for “Komen Breast Cancer group” to request to join the closed group.
  • Komen Affiliates offer breast health education and some fund breast cancer programs through local community organizations. Your local Affiliate may also help you find breast cancer resources in your area. Find your local Affiliate
  • Our fact sheets, booklets and other education materials offer additional information. 

 

 

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