Breast Cancer Screening Recommendations for 25-Year-Old Women
For average-risk 25-year-old women, breast cancer screening with mammography is not recommended, but a clinical breast examination every 1-3 years and breast awareness education should be provided.
Screening Recommendations for Average-Risk 25-Year-Old Women
Clinical Recommendations
- The National Comprehensive Cancer Network (NCCN) recommends a clinical encounter for average-risk women aged 25-39 years, which includes ongoing breast cancer risk assessment, risk reduction counseling, clinical breast examination (CBE) every 1-3 years, and encouraging women to be aware of their breasts and promptly report any changes to their healthcare provider 1
- The American College of Physicians (ACP) notes that clinical breast examination may be offered to asymptomatic, average-risk women every 1-3 years for women aged 25-39 years 1
- Breast self-examination is not recommended in average-risk women due to risk of harm from false-positive results and lack of evidence of benefit 1
- Mammography screening is not recommended for average-risk women under age 40 1
Risk Assessment
- All women should undergo breast cancer risk assessment by age 25, especially Black women and women of Ashkenazi Jewish heritage, to identify those at higher-than-average risk so appropriate screening can be initiated 2
- Risk assessment should include evaluation of family history of breast and ovarian cancer, personal medical history, and other risk factors 1
Special Considerations for High-Risk 25-Year-Old Women
Women with Genetic Predisposition
- Women with BRCA1/2 mutations or other genetic predispositions should begin breast awareness at age 18 and clinical breast examinations every 6-12 months starting at age 25 1
- For women with BRCA1/2 mutations aged 25-29, annual breast MRI screening with contrast is recommended (preferred over mammography) 1
- Mammography should begin at age 30 for these high-risk women, in addition to continuing annual MRI 1
Women with Prior Thoracic Radiation
- Women who received thoracic radiation therapy between ages 10-30 have substantially increased risk for developing breast cancer 1
- For women aged 25 and older who have undergone prior thoracic irradiation, annual mammograms and clinical breast examination every 6-12 months are recommended 1
- Screening should begin 8-10 years after radiation exposure or at age 25, whichever occurs last 1
- Annual breast MRI should be considered as part of the screening evaluation for these women 1
Women with Strong Family History
- Women with a strong family history of breast cancer should begin annual screening 10 years before the age at which their youngest affected relative was diagnosed, but generally not before age 30 3
- Approximately 10% of breast cancers are associated with a genetic predisposition 1
Potential Harms of Screening
- Early screening in average-risk young women can lead to false positives requiring additional imaging and potentially unnecessary biopsies 4
- Radiation exposure from mammography in young women is a consideration, particularly for those with genetic predispositions that may increase sensitivity to radiation 1
- The balance of benefits and harms improves with age, with fewer benefits and more potential harms in younger women 1, 3
Key Takeaways
- For average-risk 25-year-old women, clinical breast examination every 1-3 years and breast awareness education are appropriate 1
- Risk assessment should be performed by age 25 to identify women who may benefit from enhanced screening protocols 2
- High-risk women (genetic mutations, prior chest radiation, strong family history) require individualized screening protocols that may include earlier and more intensive screening with MRI and/or mammography 1, 3
- Screening recommendations become more intensive as women age, with most guidelines recommending mammography beginning at age 40 for average-risk women 5