Breast Cancer Screening Recommendations for Women at Higher Risk

Regular screening tests are very important for women who are at a higher risk of breast cancer. A woman is considered at higher risk if she has one factor that greatly increases her risk or several factors that together increase risk. Your health care provider may use different tools to assess your risk and help you make a breast cancer screening plan. For more on breast cancer risk, see the Risk Factors and Prevention section.

Factors that increase breast cancer risk a great deal include:

• A mutation (or a first-degree relative with a mutation) in the BRCA1 or BRCA2 gene.
• Strong family history of breast cancer, such as mother and/or sister diagnosed at age 40 or younger.
• Personal history of breast cancer (including DCIS), lobular carcinoma in situ (LCIS) or atypical hyperplasia.
• Radiation treatment to the chest area during childhood or young adulthood.
• A mutation (or a first-degree relative with a mutation) in the TP53 or PTEN genes. (These gene mutations can lead to have Li-Fraumeni syndrome, Cowden syndrome or Bannayan-Riley-Ruvalcaba syndrome. People with one of these syndromes or who have in a first-degree relative with one of these syndromes have an increased risk of breast cancer.)

The American Cancer Society and the National Comprehensive Cancer Network recommend that women at high risk for breast cancer be screened every year with MRI along with mammography, starting at earlier ages and perhaps more often than women at average risk [7,45-46]. Combined with standard mammography and clinical breast exam, ultrasound may also be useful for detecting cancer in women at higher risk. Any decisions about breast cancer screening should be made after talking with your health care provider.

Magnetic resonance imaging (MRI )

Magnetic resonance imaging (MRI) uses magnetic fields to create an image of the breast. MRI is more invasive than mammography because a contrast agent is injected before the procedure [25]. At this time, MRI is most often used in breast cancer diagnosis and staging, rather than in early detection. However, there is growing evidence that MRI along with mammography, compared to mammography alone, can increase detection of breast cancer in certain groups of women at higher risk due to a BRCA1 or BRCA2 gene mutation or with a strong family history [47-50]. Because insurance coverage varies, you may wish to talk to your insurance provider before getting MRI screening.

Find out more on MRI as a screening tool for women at average risk of breast cancer.

Find out more on BRCA1/2 genetic mutations.

Figure 3.5 below outlines the American Cancer Society and National Comprehensive Cancer Network recommendations for women at higher risk. 

 
Adapted from American Cancer Society's Detailed Guide: Breast Cancer, 2009 and NCCN Clinical Practice Guidelines in Oncology: Breast cancer screening and diagnosis, v.1.2009 [7,46].

Breast self-exam

Breast self-exam is a tool that can be used to increase awareness of breast cancer and to learn about what changes in the breast should be reported to your health care provider. Learn more about breast self-exam.

Updated 10/05/09

Breast Cancer Screening Recommendations for Women at Average Risk

Early Detection & Screening