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Breast Cancer Screening Recommendations for Women at Higher Risk

Regular breast cancer screening is important for all women. If you are at higher risk of breast cancer, you may need to be screened earlier and more frequently than other women.

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.

Learn more about breast cancer risk.

Women at higher risk of breast cancer

Factors that greatly increase breast cancer risk include:

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

Figure 3.5 below outlines the American Cancer Society (ACS) and National Comprehensive Cancer Network (NCCN) screening recommendations for women at higher risk of breast cancer.

Magnetic resonance imaging (MRI)

What is 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 given through an IV before the procedure.

MRI and breast cancer screening

At this time, MRI is used mostly in breast cancer diagnosis and staging, rather than in screening. However, there is growing evidence that MRI in combination with mammography, compared to mammography alone, can increase detection of breast cancer in certain women at higher [56-59]. ACS and NCCN recommend yearly screening with mammography plus MRI for women who [18,60]:

Are BRCA1 or BRCA2 mutation carriers or first-degree relatives of a BRCA1 or BRCA2 carrier, but have not been tested for BRCA1/2 mutations and are ages 25 or older
Have a strong family history of breast or ovarian cancer (for example, two or more first-degree relatives with breast cancer or two or more with ovarian cancer) and are ages 25 or older, starting at the age five to 10 years prior to the youngest breast cancer case in the family
Had radiation treatment to the chest between ages 10 and 30 years and are ages 25 or older, starting eight to 10 years after radiation treatment or at age 25 (whichever age occurs last)
Have Li-Fraumeni, Cowden or Bannayan-Riley-Ruvalcaba syndrome and their first-degree relatives
Are at greater than 20 percent average lifetime risk of invasive breast cancer (Estimate your five-year risk or learn more about risk.)

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

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

Insurance coverage of MRI screening

Because insurance coverage varies, you may wish to talk to your insurance provider before getting MRI screening.

Learn more about MRI as a screening tool for women at average risk of breast cancer.

Learn more about BRCA1 and BRCA2 genetic mutations.

Ultrasound

Combined with mammography and clinical breast exam, ultrasound may be useful for detecting cancer in women at higher risk [61].

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