Breast Cancer Screening for Women at Higher Risk

Routine breast cancer screening is important for all women, but even more so for those at higher 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 of breast cancer 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 breast cancer screening plan that’s right for you.

Learn more about breast cancer risk.

Learn about breast cancer screening for women who’ve had breast cancer.

Women at higher risk of breast cancer

Factors linked to a higher risk of breast cancer include [3,66]:

A BRCA1 or BRCA2 inherited gene mutation (and first-degree relatives (parents, siblings and children) of people with BRCA1/2 gene mutations who have not been tested for BRCA1/2 gene mutations themselves)
A personal history of invasive breast cancer or ductal carcinoma in situ (DCIS)
A personal history of lobular carcinoma in situ (LCIS) or atypical hyperplasia
Radiation treatment to the chest area between ages 10-30
Li-Fraumeni syndrome or Cowden/PTEN syndrome (and first-degree relatives)
An ATM, BARD1, CDH1, CHEK2, NF1, PALB2, PTEN, RAD51C, RAD51D, STK11 or TP53 inherited gene mutation
A greater than 20% lifetime risk of invasive breast cancer based mainly on family history (Estimate your lifetime risk or learn more about risk.)

Breast cancer screening guidelines for women at higher risk

The American Cancer Society (ACS) and the National Comprehensive Cancer Network (NCCN) have breast cancer screening guidelines for women at higher risk.

Figure 3.5 below outlines the ACS breast cancer screening guidelines for women at higher risk.

Figure 3.6 below outlines the NCCN breast cancer screening guidelines for women at higher risk, ages 75 and younger. The NCCN recommends women older than 75 talk with their health care providers about a breast cancer screening plan that’s right for them.

The NCCN guidelines differ somewhat from the ACS guidelines.

Figure 3.5: ACS breast cancer screening recommendations for women at higher 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 inherited gene mutation or a first-degree relative with a BRCA1/2 inherited gene mutation, but have not been tested for BRCA1/2 inherited 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 before age 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 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% to 25% 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 [2].

Learn more about clinical breast exam.

Learn more about mammography.

Learn more about breast MRI.

Figure 3.6: NCCN breast cancer screening recommendations for women at higher risk
Risk factor	Clinical breast exam	Mammogram with digital breast tomosynthesis	Breast MRI
Lobular carcinoma in situ (LCIS) and a 20% or greater 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†

Atypical hyperplasia and a 20% or greater 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 inherited 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 30-75
	Every 6-12 months	Every year	Every year

A first-degree relative with a BRCA1/2 inherited gene mutation, but not tested for BRCA1/2 inherited gene mutations themselves*	Every 6-12 months	Every year starting at age 40 or starting 10 years before the age of the youngest breast cancer case in the family (whichever comes first, but not starting before age 30)	Every year starting at age 40 or starting 10 years before the age of the youngest breast cancer case in the family (whichever comes first, but not starting before age 25)

Radiation treatment to the chest between ages 10-30	Younger than 25
	Every year starting 8 years after radiation treatment	Not recommended	Not recommended
	Ages 25-75
	Every 6-12 months starting 8 years after radiation treatment	Every year starting 8 years after radiation treatment	Every year starting 8 years after radiation treatment†

Li-Fraumeni syndrome or TP53 inherited gene mutation	Ages 20-29
	Every 6-12 months starting at age 20 or starting at the age of the youngest breast cancer case in the family (whichever comes first)	Only if breast MRI not available: Every year starting at age 20 or starting at the age of the youngest breast cancer case in the family (whichever comes first)	Every year starting at age 20 or starting at the age of the youngest breast cancer case in the family (whichever comes first) If breast MRI not available, then mammogram
	Ages 30-75
	Every 6-12 months	Every year	Every year

Cowden/PTEN syndrome or PTEN inherited gene mutation	Every 6-12 months starting at age 25 or starting 5-10 years before the age of the youngest breast cancer case in the family (whichever comes first)	Every year starting at age 30 or starting 10 years before the age of the youngest breast cancer case in the family (whichever comes first)	Every year starting at age 30 or starting 10 years before the age of the youngest breast cancer case in the family (whichever comes first)

ATM or CHEK2 inherited 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 30-35

BARD1 inherited 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 inherited 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

NF1 inherited 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 or STK11 inherited 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

RAD51C or RAD51D inherited 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

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

Estimated risk	Clinical breast exam	Mammogram with digital breast tomosynthesis	Breast MRI
Women ages 35 and older with a 5-year risk of invasive breast cancer of 1.7% or higher by the Gail Model (Estimate your 5-year risk or learn more about risk.)	Every 6-12 months starting at age found to be at increased risk by the Gail Model	Every year starting at age found to be at increased risk by the Gail Model	Not recommended

Women at greater than 20% 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 at age 40 or starting 10 years younger than the youngest breast cancer case in the family (whichever comes first, but not before age 30)	Every year starting at age 40 or starting 10 years younger than the youngest breast cancer case in the family (whichever comes first, but not before age 25)†
* Talk with your health care provider about getting genetic counseling. † If you cannot have a breast MRI for medical reasons, contrast-enhanced mammography or molecular breast imaging may be considered. If these are not available, whole breast ultrasound may be considered. ‡ Talk with your health care provider about the risks and benefits of additional types of imaging. Adapted from NCCN materials [3,66-67].

Learn more about clinical breast exam.

Learn more about mammography.

Learn more about breast MRI.

Affordable Access to Breast Imaging

Susan G. Komen^® believes all people should have access to regular screening when they and their health care providers decide it’s best based on their personal risk of breast cancer.

Komen’s Center for Public Policy is working with state and federal lawmakers to ensure needed screening and diagnostic imaging are covered by health plans, with no out-of-pocket costs for patients.

Watch our video of Komen grantee Dr. Tarah Ballinger who shares why it’s important to know if you’re at higher risk of breast cancer.

Breast magnetic resonance imaging (MRI)

Breast MRI uses magnetic fields to create an image of the breast. It’s not routinely used in breast cancer screening.

However, compared to mammography alone, mammography plus breast MRI is better at finding breast cancer in some women at higher risk [68-71].

The NCCN recommends screening with mammography plus breast MRI for some women at higher risk of breast cancer, including those with [3,66]:

A BRCA1 or BRCA2 inherited gene mutation
A first-degree relative (parent, sibling or child) with a BRCA1/2 inherited gene mutation, but have not been tested for BRCA1/2 inherited gene mutations themselves
Li-Fraumeni syndrome or Cowden/PTEN syndrome (and first-degree relatives)
A PALB2, PTEN, STK11 or TP53 inherited gene mutation
Radiation treatment to the chest area between ages 10-30
A greater than 20% 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, BARD1, CDH1, CHEK2, NF1, RAD51C or RAD51D inherited gene mutation consider breast MRI as part of their breast cancer screening [66].

If you’re getting a mammogram and a breast MRI every year for screening, your health care provider may stagger the tests, so you get one test every 6 months.

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

Learn more about breast MRI, including the downsides to breast MRI, insurance coverage and more.

Susan G. Komen^® Support Resources

Do you need more information about breast cancer screening or low-cost programs in your area? We’re here for you. The Komen Patient Care Center is your trusted, go-to source for timely, accurate breast health and breast cancer information, services and resources. Our navigators offer free, personalized support for you and your loved ones including education, emotional support, financial assistance, help accessing care and more. Get connected to a Komen navigator by contacting the Breast Care Helpline at 1-877-465-6636 or email helpline@komen.org to get started. All calls are answered Monday through Thursday, 9 a.m. to 7 p.m. ET and Friday, 9 a.m. to 6 p.m. ET. Se habla español.
The Komen Breast Cancer and Komen Metastatic (Stage IV) Breast Cancer Facebook groups are places where those with breast cancer and their family and friends can talk with others for friendship and support.
Our Real Pink podcast series features candid conversations with breast cancer patients, survivors, researchers, physicians and more.
Our fact sheets, booklets and other education materials offer additional information.

Updated 03/18/25

This content is regularly reviewed by an expert panel including researchers, practicing clinicians and patient advocates.

TOOLS & RESOURCES

Fact Sheet

Breast Cancer Screening and Follow-Up Tests