From the Guidelines
A 33-year-old female with a possible family history of breast cancer in her grandmother should discuss screening options with her healthcare provider rather than immediately pursuing a mammogram. The American College of Radiology recommends starting mammograms at age 40 for average-risk women 1. For someone with a family history, the recommendation depends on several factors including the age at which the relative was diagnosed, whether it was a first-degree relative (mother, sister, daughter), and if genetic testing has confirmed hereditary cancer syndromes. At 33, with only a grandmother potentially affected, she likely doesn't meet criteria for early mammography screening, as high-risk women should begin annual screening mammography at 30 years of age or 10 years prior to the youngest family member who had breast cancer, but generally not before 30 years of age 1.
Instead, she should:
- Clarify her family history details with relatives if possible
- Consider a formal risk assessment with her doctor
- Practice monthly breast self-exams
- Her provider might recommend genetic counseling if multiple family members have had breast or related cancers
- Regular clinical breast exams by a healthcare provider are also important The radiation exposure from mammograms, though small, is another reason they aren't routinely recommended for younger women without significant risk factors 1.
From the Research
Breast Cancer Risk Assessment
- A 33-year-old female with a family history of breast cancer, specifically a grandmother with breast cancer, may be at increased risk for hereditary breast cancer (HBC) 2.
- According to the study, women with a family history of breast cancer should be stratified into low, moderate, or high risk groups based on certain features in their family history 2.
- The study suggests that women with none of the features of increased risk are at low risk for HBC and should have annual clinical breast examinations and mammography at least every 2 years starting at age 50 2.
- However, women with one or more features of increased risk who do not meet criteria for referral to a familial cancer clinic are at moderate risk for HBC and should begin annual mammography and clinical breast examination at age 40 2.
Screening Recommendations
- For women with a family history of breast cancer, the American College of Radiology recommends annual mammography starting at age 40, or 10 years before the age of the youngest affected relative 2.
- However, for women with BRCA mutations, who choose to decline or defer risk-reducing mastectomy, a highly sensitive breast screening regimen should be started by age 25 or 30, including annual mammography and magnetic resonance imaging (MRI) 3.
- A study on the cost-effectiveness of alternating magnetic resonance imaging and digital mammography screening in BRCA1 and BRCA2 gene mutation carriers found that alternating MRI and DM screening at 6-month intervals beginning at age 30 years was a clinically effective approach 4.
Family History and Risk Assessment
- A family history score (FHS) that takes account of the expected number of family cases based on the family's age-structure and national cancer incidence rates can give greater risk discrimination on breast cancer incidence than conventional parameters based solely on cases in affected relatives 5.
- The study found that breast cancer risk increased significantly with greater FHS, and that a combination of FHS and age of relative at diagnosis was the best model for determining breast cancer risk due to family history 5.
- Another study found that using a screening tool at a breast imaging center can increase referral of at-risk women for genetic counseling and BRCA testing, leading to improved clinical risk management 6.