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 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.
Learn about breast cancer screening for women who’ve had breast cancer.
Women at higher risk of breast cancer
Factors linked to a high breast cancer include [3,68]:
- A BRCA1 or BRCA2 inherited gene mutation (and first-degree relatives (parents, siblings and children) of people with BRCA1/2 gene mutations who have not been tested for BRCA1/2 gene 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 syndrome or Cowden/PTEN 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. The ACS guidelines 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 |
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† |
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Atypical hyperplasia and a greater than 20 percent lifetime risk of invasive breast cancer |
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† |
Ages 25-29 |
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Every 6-12 months |
Only if breast MRI not available: |
Every year |
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Ages 30-75 |
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Every 6-12 months |
Every year |
Every year |
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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 30) |
Radiation treatment to the chest between ages 10-30 |
Younger than 25 |
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Every year starting 8 years after radiation treatment |
Not recommended |
Not recommended |
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Ages 25-29 | |||
Every 6-12 months starting 8 years after radiation treatment |
Not recommended |
Every year starting 8 years after radiation treatment† |
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Ages 30-75 |
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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† |
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Li-Fraumeni syndrome or a TP53 inherited gene mutation |
Ages 20-29 |
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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 |
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Ages 30-75 |
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Every 6-12 months |
Every year |
Every year |
|
Cowden/PTEN syndrome or a 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 30-35 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 30-35 or starting 5-10 years before the age of the youngest breast cancer case in the family (whichever comes first) |
An ATM, BARD1 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 40 |
A 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 |
An 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 |
A PALB2 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 |
A BRIP1, NBN, RAD51C, RAD51D or STK11 inherited 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 |
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 |
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Atypical hyperplasia with a 20 percent or less lifetime risk of invasive breast cancer |
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 by the Gail Model |
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 percent lifetime risk of invasive breast cancer based mainly on family history* |
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, 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 [3,68-69]. |
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Figure 3.6: ACS breast cancer screening recommendations for women at higher than average risk | |||
Risk factor |
Clinical breast exam |
Mammogram |
Breast MRI |
Not recommended |
Every year |
Talk with your health care provider |
|
Not recommended | Every year | Talk with your health care provider |
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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 |
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 |
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. |
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 [70-73].
The NCCN recommends screening with mammography plus breast MRI for some women at higher risk of breast cancer, including those with [3,68]:
- 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
- Radiation treatment to the chest area between ages 10-30
- Li-Fraumeni syndrome or Cowden/PTEN 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 [68].
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 digital mammography [3].
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 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
If you’re at high risk of breast cancer and 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 inherited gene mutations.
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 |
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Updated 11/09/21
