Risk and Screening of Breast Cancer

Risk and Screening of Breast Cancer

As many as 1 in 8 women may develop breast cancer during her lifetime. Many women do not have signs or symptoms when they are diagnosed, so it is important to understand your risk and get screened regularly.

If you have a higher risk for breast cancer, or if the results of a recent exam or mammogram are causing concern, Northwestern Medicine’s teams of physician specialists are here to help.

At Northwestern Medicine, we’ll help you better understand your risk and provide the most personalized, advanced breast care in the region. We’ve even developed more inclusive, detailed guidelines, based on our cancer specialists’ experience, for women at high, above-average and average risk.

American Cancer Society definition for high risk of breast cancer

Recent studies have shown the benefits of defining different levels of breast cancer risk in women. In April 2007, The American Cancer Society released the following new guidelines for women at high risk of developing breast cancer:

  • Women who have a first-degree relative with the BRCA1 or BRCA2 gene mutation have an 85 percent greater risk of developing breast cancer. These genes are involved in cell growth, division and DNA repair which, when mutated, increase an individual’s risk.
  • Women with multiple first-degree relatives with breast and/or ovarian cancer, or with one or more first-degree relatives with pre-menopausal breast cancer, have a 20 to 25 percent or greater lifetime risk of developing breast cancer.
  • Individuals who received chest radiation between 10 and 30 years of age for cancers such as Hodgkin’s disease are at higher risk.
  • Women with Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or who have a first-degree relative with one of these rare cancer predisposition syndromes, are at higher risk for breast cancer.

Northwestern Medicine Breast Cancer Screening Guidelines

Northwestern Medicine’s guidelines for high risk are based on those published by The American Cancer Society. However, the Society’s guidelines do not cover all groups of women with above-average risk factors.

In keeping with our dedication to individualized breast care, we’ve established a more detailed, inclusive set of guidelines for three specific risk groups along with recommended screening procedures:

High Risk Checklist

By our criteria, the following factors define a woman at high risk for breast cancer:

  • Mother or sister diagnosed with breast cancer before age 50 or before menopause
  • Two or more close relatives with breast and/or ovarian cancer, at least one being a mother, sister or daughter
  • Three close relatives diagnosed with breast cancer at any age*
  • A father, brother or son diagnosed with breast cancer
  • A mother, sister or daughter diagnosed with bilateral breast cancer, with the first cancer diagnosed before age 50
  • Personal history of bilateral breast cancer

Two or more of the following:

  • Atypical ductal hyperplasia or lobular carcinoma in situ on a previous biopsy
  • Personal history of breast cancer
  • One or more close relatives with breast and/or ovarian cancer
  • BRCA1 or BRCA2 mutation or a first-degree relative with this mutation
  • Chest radiation received between the ages of 10 and 30
  • Other rare gene mutations, such as the TPS3 gene, PTEN gene, ATM gene, CHEK2 gene

Additional Screening Strategies for Women at High Risk

Aside from exams and mammograms, women at high risk may benefit from an annual breast MRI. The MRI is a diagnostic tool more sensitive than mammography at detecting breast cancer, and may be used in conjunction with a mammographic view or ultrasound to aid in proper diagnosis.

The following screening procedures are recommended for women at high risk:

  • Annual mammography beginning at age 30, or 10 years earlier than the youngest relative diagnosed with breast cancer. It is not recommended to undergo mammography prior to age 20.
  • Annual breast MRI beginning at age 30, or 10 years earlier than the youngest relative diagnosed with breast cancer. It is not recommended to undergo breast MRI prior to age 20.
  • Annual clinical breast exam beginning at age 30
  • Monthly self breast exam beginning at age 20 is also an option

* “Close relative” is defined as a parent, brother or sister, child, grandparent, aunt or uncle, nephew or niece. The affected relatives must come from the same side of the family, such as the mother’s or father’s side.

Above-Average Risk Checklist

The following factors define a woman as above-average risk for breast cancer:

  • Atypical ductal hyperplasia or lobular carcinoma in situ on a previous biopsy
  • Previous history of breast cancer
  • One close relative with breast cancer diagnosed after age 50

Please keep in mind that if you have one of the above factors in combination with dense breast tissue or multiple previous biopsies, you may be at high risk for developing breast cancer. And you should be aware that other health factors, such as early menarche, late menopause, having no children (or having them late in life), alcohol consumption and hormone therapy might also increase your risk.

Screening Strategies for Women at Above-Average Risk

The following screening procedures are recommended for women at above-average risk:

  • Annual mammography beginning at age 40—you may also seek a baseline mammogram at age 35
  • Clinical breast exam every three years in your 20s and 30s and annually after age 40
  • Monthly self breast exam beginning at age 20 is also an option

Average or Low Risk Checklist

The following factors define a woman at average or low risk for breast cancer:

  • No personal history of breast cancer, atypical ductal hyperplasia or lobular carcinoma in situ
  • No significant family history of breast cancer

Screening Strategies for Women at Average or Low Risk

The following screening procedures are recommended for women at average or low risk:

  • Annual mammography beginning at age 40
  • Clinical breast exam every three years in your 20s and 30s and annually after age 40
  • Monthly self breast examinations beginning at age 20 is also an option

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