Recommendations

Recommendations for Women with Higher Risk

Getting regular screening tests is very important for women who are at a higher risk of developing breast cancer. In general, a woman can be placed in the higher-risk category if she has either a single factor that greatly increases her risk or a combination of lesser factors that together increase risk. For more on estimating breast cancer risk, see the Risk Factors and Prevention section.
Factors that can single-handedly increase a woman's risk a great deal include:

Although the benefit is not clear, both the American Cancer Society and the National Comprehensive Cancer Network recommend that women at high risk for breast cancer be screened with MRI in addition to mammography, with screening beginning at earlier ages and perhaps more often than women at average risk [42-44]. In addition to standard mammography and clinical breast exam, ultrasound may also be useful for detecting cancer in women at higher risk. Of course, any decisions about screening should be made only after talking with your health care provider.

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 to help with the diagnosis and staging of cancer, rather than detect cancer. However, there is growing evidence that MRI also offers some benefit in the early detection of breast cancer, especially among certain groups of women at higher risk. Compared to mammography alone, MRI with mammography has been shown to increase detection of breast cancer in women at higher risk due to a genetic mutation in the BRCA1 or BRCA2 gene or with a strong family history [45-50]. Because coverage varies, before getting MRI screening, you may wish to talk to your insurance provider as well as your health care provider.

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

Figure 3.5: Options for screening frequency in women at increased risk of breast cancer

Risk Category

Screening Schedule

Clinical Breast Exam

Mammogram

Breast Self- Exam

MRI in combination with mammography

Five-year risk of invasive breast cancer of 1.7 percent or higher in women ages 35 and older.
(To estimate your five-year risk, click here.)
(For more information on risk, click here.)

Every 6-12 months

Every year

Encouraged

Not recommended

LCIS or atypical hyperplasia

Every 6-12 months

Every year

Encouraged

Recommend considering and talking to your health care provider

Carrier of BRCA1 or BRCA2 mutation

Every 6-12 months

Every year

Encouraged

Every year

First-degree relative of BRCA1 or BRCA2 carrier, but have not been tested for these genetic mutations.

Every year

Every year

Encouraged

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)

Under age 25

Every year

Not recommended

Encouraged

Not recommended

Age 25 and over

Every 6-12 months

Every year

Encouraged

Every year

Received radiation to the chest between ages 10 and 30 years

Every year

Every year

Encouraged

Every year

Women with Li-Fraumeni syndrome and their first-degree relatives

Every year

Every year

Encouraged

Every year

Women with Cowden and Bannayan-Riley-Ruvalcaba syndromes and their first-degree relatives

Every year

Every year

Encouraged

Every year

Personal history of cancer or DCIS

Every year

Every year

Encouraged

Recommend considering and talking to your health care provider

Women with dense breast tissue

Every year

Every year

Encouraged

Recommend considering and talking to your health care provider

Women at 20.1 to 25 percent greater than average lifetime risk of invasive breast cancer
(To estimate your lifetime risk, click here.)
(For more information on risk, click here.)

Every year

Every year

Encouraged

Every year

Women at 15 to 20 percent greater than average lifetime risk of invasive breast cancer
(To estimate your lifetime risk, click here.)
(For more information on risk, click here.)

Every year

Every year

Encouraged

Recommend considering and talking to your health care provider

Women at average or low (less than 15 percent greater than average) lifetime risk of invasive breast cancer
(To estimate your lifetime risk, click here.)
(For more information on risk, click here.)

Every year

Every year

Encouraged

Not recommended

Adapted from American Cancer Society's Detailed Guide: Breast Cancer, 2007 and NCCN Practice Guidelines in Oncology: Breast Screening and Diagnosis Guidelines, v1.2008 [43,44].

Copyright 2017. Sandra O'Neal Institute of North Texas
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