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If I have a family history of breast cancer, how should I be screened?

Laurie R. Margolies, MD
Diagnostic Radiology

Women with a family history of breast cancer should be screened for breast cancer. The exact screening plan does, however, depend upon the relationship of those within the family who had breast cancer, the age at which they were diagnosed and your age. If there is a strong family history of breast cancer in first degree relatives (mother, sister, daughter) genetic screening for breast cancer genes may also be useful.

In general, it is suggested that screening begin 10 years younger than a first degree relative developed breast cancer, but not before age 25. For example, if your mother developed breast cancer at age 42, you should begin screening at age 32. Most people believe that early high risk screening should include a mammogram. Supplemental screening with ultrasound – that is having a mammogram and an ultrasound - has also been shown to find more cancers than mammography alone. The American Cancer Society also recommends yearly breast MRI for some high risk women including those who have BRCA mutations, those whose family history would suggest that they might have this mutation, and those whose calculated lifetime risk of breast cancer is 20 -25%. 

Carrie Bilicki
Oncology Nursing

Beyond family history, there are other factors that have been associated with increasing risk for developing breast cancer in women. In the general population, these risk factors for the development of cancer is age, with the majority of breast cancers occurring in women ages 60-79, and hormonal factors, and if any previous breast biopsy. By taking into account all this information, your physician will develop management recommendations. As part of your physician recommendations, a referral to a genetic counselor for hereditary risk assessment and possible genetic testing may be considered.

If the pattern may be genetic, then genetic counseling and possible genetic testing would be the first place to start. If genetic testing is not indicated, not done, or not revealing, then your risk could be quantitated. This would help determine whether to add additional screening such as breast MRI or to consider chemoprevention to reduce your risk. If you have a familial pattern of breast cancer but no clear-cut gene that can be determined, then generally it is best to begin cancer screening 10 years earlier than the youngest age at which a member of the family had breast cancer diagnosed. The routine age to begin screenings is 40, so this could mean starting in the 30s or even the 20s.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.