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 [144-145]:

A BRCA1 or BRCA2 gene inherited mutation (and first-degree relatives of people with BRCA1/2 mutations who have not been tested for BRCA1/2 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, Cowden/PTEN or Bannayan-Riley-Ruvalcaba syndrome (and first-degree relatives)
An ATM, BARD1, BRIP1, CDH1, CHEK2, NBN, NF1, PALB2, PTEN, RAD51C, RAD51D, STK11 or TP53 inherited 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.)

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 30-75
	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 or 10 years before the age of the youngest breast cancer case in the family (whichever comes first)	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 8 years after radiation treatment	Not recommended	Not recommended
	Ages 25-29
	Every 6-12 months starting 8 years after radiation treatment	Not recommended	Every year starting 8 years after radiation treatment‡
	Ages 30-75
	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 a 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 30-75
	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, BARD1 or CHEK2 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
A 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
A 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
A BRIP1, RAD51C, RAD51D or 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 (but not before age 21)	Every year starting at age 40 or 10 years younger than the youngest breast cancer case in the family (whichever comes first, 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. † Talk with your health care provider about getting genetic counseling. ‡ If you cannot have a breast MRI for medical reasons, whole breast ultrasound or contrast-enhanced mammography may be considered. § Talk with your health care provider about the risks and benefits of additional types of imaging. Adapted from NCCN materials [60,144-145].

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 [144-145]:

A BRCA1 or BRCA2 inherited 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)
A PALB2, PTEN or TP53 inherited 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, BARD1, CDH1, CHEK2 or NF1 inherited 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 or contrast-enhanced mammography [144].

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.

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 [144].
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.
Our fact sheets, booklets and other education materials offer additional information.

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Updated 12/10/20