The Who, What, Where, When and Sometimes, Why.

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 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.

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

Women at higher risk of breast cancer

Factors linked to a higher breast cancer include [163-164]:

Breast cancer screening guidelines for women at higher risk

The American Cancer Society (ACS) and the National Comprehensive Cancer Network (NCCN) are two organizations that 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.

The NCCN guidelines differ somewhat from the ACS guidelines.

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.

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 not 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 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% 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 [8].

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†

Lobular carcinoma in situ (LCIS) with a less than 20% 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

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†

Atypical hyperplasia with a less than 20% 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

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 25-29

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

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 (but not before age 21)

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 [71,163-164].

When you schedule your screening appointment, make sure it’s covered by your insurance. Your health care provider can help.

Find information on what to do if an insurance claim is denied.

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’s best based on their risk of breast cancer.

Komen also believes screening should be covered by insurance companies, government programs and other third-party payers, with no out-of-pocket costs for patients.

 

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.

Breast MRI in combination with mammography is better than mammography alone at finding breast cancer in certain women at higher risk [72-75]. However, there are not yet long-term studies to understand if this leads to fewer deaths from breast cancer. Also, there are some downsides to breast MRI.

The NCCN recommends screening with mammography plus breast MRI for some women at higher risk of breast cancer, including those with [163-164]:

  • 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 [164].

Women at higher risk of breast cancer who are recommended to have breast MRI as part of their breast cancer screening, but cannot have one for medical reasons, may consider contrast-enhanced mammography or molecular breast imaging may be considered [163]. If these are not available, whole breast ultrasound may be considered [163].

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.

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

 52805-2.gifFor a summary of research studies on breast cancer screening with breast MRI plus mammography and mammography alone for women at high risk of breast cancer, visit the Breast Cancer Research Studies section.

Timing of breast MRI screening

If you’re at high risk of breast cancer and getting a mammogram 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 more about health insurance.

Under study: Screening with breast MRI for women who’ve had breast cancer

Mammography plus breast MRI is under study for screening for new breast cancers in women who’ve had breast cancer. It’s not clear whether or not screening with breast MRI offers a benefit to women who’ve had breast cancer. It’s also not clear whether any potential benefits outweigh the risks. So, it’s not routinely recommended.

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

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 fact sheets, booklets and other education materials offer additional information.

Updated 12/27/23

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