At what age should a 37-year-old female with a family history of breast cancer, including a mother diagnosed at age 63 and two maternal aunts, start undergoing mammography (breast imaging) screenings?

From the Guidelines

For a 37-year-old female with a mother who had breast cancer at age 63 and two maternal aunts with breast cancer, mammogram screening should begin at age 40, as the family history does not meet criteria for high-risk screening that would warrant starting mammograms earlier than age 40 1. This recommendation follows standard guidelines for women with this level of family history. While the family history is significant, it does not meet criteria for high-risk screening that would warrant starting mammograms earlier than age 40. The mother's diagnosis after age 50 and the maternal aunts' history represent an increased but not dramatically elevated risk.

Key Considerations

• The degree of breast cancer mortality reduction from screening mammography varies with different screening regimens, with mortality reduction being greater when screening begins at 40 years of age rather than 45 or 50 years of age and when screening is done more frequently (annually rather than biennially) 1.
• Beginning screening at an earlier age and more frequent screening result in a greater number of imaging studies performed, so these screening regimens also increase the number of false-positive examinations and biopsies 1.
• Once screening begins, it should be performed annually, and the woman should have regular clinical breast exams and practice monthly breast self-examinations.
• She might also benefit from a formal risk assessment using models like Gail or Tyrer-Cuzick to determine if she qualifies for additional screening or risk-reduction strategies.

Benefits and Risks

• The benefits of early detection of breast cancer through mammogram screening include a reduction in breast cancer mortality, with a 22% reduction in mortality demonstrated in multiple randomized controlled trials 1.
• The risks of screening mammograms include false-positive recalls and biopsies, overdiagnosis, and patient anxiety, with approximately 10% of screening mammograms resulting in a recall for additional imaging 1.
• The recommendation balances the benefits of early detection against potential harms of false positives and unnecessary procedures in younger women whose breast tissue is typically denser, making mammograms less effective.

Screening Recommendations

• The ACR recommends annual screening mammography beginning no later than 40 years of age for women at intermediate risk 1.
• For those with a family history of breast cancer, mammography should begin earlier if familial breast cancer occurred at a young age, typically 10 years prior to the youngest age at presentation but generally not before age 30 1.

From the Research

Mammogram Screening for a 37-Year-Old Female with Family History of Breast Cancer

• The provided studies do not directly address the question of when to start mammograms for a 37-year-old female with a family history of breast cancer, specifically a mother who had breast cancer at age 63 and two maternal aunts who had breast cancer.
• However, the studies suggest that women with a BRCA1 or BRCA2 mutation should start annual screening with MRI and mammography by age 25 or 30 2, 3, 4.
• For women with a family history of breast cancer but without a known BRCA1 or BRCA2 mutation, the studies do not provide a clear recommendation for the start age of mammogram screening.
• It is worth noting that the studies focus on the effectiveness of MRI and mammography screening in reducing breast cancer mortality in women with BRCA1 or BRCA2 mutations, rather than providing guidance on screening for women with a family history of breast cancer without a known mutation.
• One study found that exposure to mammography in women with BRCA1 and BRCA2 mutations is not associated with an increased risk of breast cancer 5.
• Another study suggested that annual surveillance with MRI is associated with a significant reduction in the incidence of advanced-stage breast cancer in BRCA1 and BRCA2 carriers 3.
• A more recent study found that MRI surveillance was associated with a significant reduction in breast cancer mortality compared with no MRI surveillance in women with a BRCA1 sequence variation 4.