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Breast Cancer Screening Recommendations for Women at Higher Risk

Regular breast cancer screening is important for all women, but even more so for those at higher risk. If you are at higher risk of breast cancer, you may need to be screened earlier and more often 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 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:

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

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 through an IV before the test.

Breast MRI and breast cancer screening

At this time, breast MRI is mostly used in breast cancer diagnosis and staging, rather than in screening. However, there is growing evidence that breast MRI in combination with mammography, compared to mammography alone, can increase detection of breast cancer in certain women at high risk [57-60]. Figure 3.5 below outlines the ACS and NCCN recommended screening with mammography plus breast MRI for some women with a higher risk of breast cancer, including those with [18,20]:

  • BRCA1 or BRCA2 mutation  
  • A first-degree relative with a BRCA1 or BRCA2 mutation, but personally have not been tested for BRCA1/2 mutations
  • 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)
  • Radiation treatment to the chest area during childhood or young adulthood
  • Li-Fraumeni, Cowden or Bannayan-Riley-Ruvalcaba syndrome (or family has a known mutation in the TP53 or PTEN genes)

ACS and/or NCCN also recommend that certain women who have a moderately increased risk of breast cancer talk to their health care providers about the risks and benefits of screening with mammography plus breast MRI. Women who should consider mammography plus breast MRI include those who have [18,25]:

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

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

Insurance coverage of breast MRI screening

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

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

Learn more about BRCA1 and BRCA2 gene 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 right for you.   

Breast cancer screening recommendations for women at higher risk

Figure 3.5: ACS and NCCN breast cancer screening recommendations
for women at higher risk  

 

Risk factor 

 

Clinical breast exam

 

Mammogram

 

Breast MRI and mammogram

 

Lobular carcinoma in situ (LCIS)   

Every 6 to 12 months

Every year

Talk to your health care provider

Atypical hyperplasia  

Every 1 to 3 years
ages 25 to 39

Every year starting at age 40

Every year

Talk to your health care provider

BRCA1 or BRCA2 mutation 

or

first-degree relative has a BRCA1 or BRCA2 mutation, but personally have not been tested for BRCA1/2 mutations  

Under age 25

 

Every year

Not recommended

Not recommended

Age 25 and older

 

Every 6 to 12 months

Every year

Every year

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)  

Age 30 and over

 

Every 6 to 12 months

Every year

Every year

Radiation treatment to the chest between ages 10 and 30  

Under age 25

 

Every year starting 8 to 10 years after radiation treatment

Not recommended

Not recommended

Age 25 and over

 

Every 6 to 12 months

Every year starting 8 to 10 years after radiation treatment or at age 40 (whichever age comes first)

Every year starting 8 to 10 years after radiation treatment or at age 40 (whichever age comes first)

Li-Fraumeni syndrome or family has a known P53 gene mutation 

Every 6 to 12 months starting at age 20 to 25 or 5 to 10 years prior to the age of the youngest breast cancer case in the family (whichever comes first)

Every year

Talk to your health care provider about starting between ages 20 to 25

Every year

Talk to your health care provider about starting between ages 20 to 25

Cowden syndrome, Bannayan-Riley-Ruvalcaba syndrome or family has a known PTEN mutation  

Every 6 to 12 months starting at age 25 or 5 to 10 years prior to the age of the youngest breast cancer case in the family (whichever comes first)

Every year starting between ages 30 and 35 (or at the age recommended by your health care provider)

Every year starting between ages 30 and 35 (or at the age recommended by your health care provider)

Personal history of cancer (including DCIS), but no suggested family history of breast, ovarian or certain other cancers  

Every 3 to 6 months after treatment ends for the first 3 years

Every 6 to 12 months for years 4 and 5

Every year starting year 6

Every year

Talk to your health care provider

Women with dense breast tissue  

Every year 1 to 3 years starting ages 25 to 39

Every year starting at age 40

Every year starting at age 40

Talk to your health care provider

Risk category

 

Clinical breast exam

 

Mammogram

 

Breast MRI and mammogram

 

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 to 12 months

Every year

Not recommended

Women at 15 to 20 percent greater than average lifetime risk of invasive breast cancer

(Estimate your lifetime risk or learn more about risk.)

Every year

Every year

Talk to your health care provider

Women at greater than 20 percent average lifetime risk of invasive breast cancer

(Estimate your lifetime risk or learn more about risk.)

Every 6 to 12 months starting at age 30

Every year starting at age 30

Talk to your health care provider about every year starting at age 30

Adapted from ACS and NCCN materials [18,20].

 

Breast self-exam

Breast self-exam is not recommended as a screening tool for breast cancer. Learn more about breast self-exam.

 

Komen Support Resources  

  • Our breast care helpline 1-877 GO KOMEN (1-877-465-6636) provides free, professional support services and help finding local support groups. Our trained and caring staff are available to you and your family Monday through Friday from 9:00 a.m. to 10:00 p.m. EST and from 6:00 a.m. to 7:00 p.m. PST. 
     
  • Our Message Boards offer online forums to share your thoughts or feelings about subjects related to breast cancer. Our Women at Higher Risk of Breast Cancer forum within the Message Boards offers women at higher risk a place to share their own unique experiences and challenges.
 

 

Updated 11/01/13

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