From the Guidelines
Women with a maternal history of breast cancer diagnosed at age 30 should begin annual mammography screening at age 30, which is 10 years earlier than the age at which their mother was diagnosed, as recommended by the American College of Radiology 1. This approach is based on the principle that having a first-degree relative (mother) diagnosed with breast cancer at a young age increases a woman's lifetime risk of developing breast cancer, and earlier detection improves treatment outcomes and survival rates. The American College of Radiology suggests that high-risk women, including those with a family history of breast cancer, 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. Some key points to consider in the screening approach for these women include:
- Annual mammography screening starting at age 30
- Clinical breast exam performed by a healthcare provider every 6-12 months starting at age 25
- Consideration of genetic counseling to evaluate risk for hereditary breast cancer syndromes, particularly BRCA1/2 mutations
- Potential for more intensive surveillance, including breast MRI alternating with mammography every 6 months, if genetic testing reveals a pathogenic mutation
- Practice of monthly breast self-awareness and prompt reporting of any changes to the healthcare provider The goal of this enhanced screening approach is to reduce morbidity and mortality from breast cancer by detecting the disease at an early stage, when treatment is more effective. As noted in the studies, screening mammography has been shown to decrease breast cancer mortality, with the degree of reduction varying based on the screening regimen and individual patient risk factors 1. Ultimately, the decision to start screening mammography at age 30 for women with a maternal history of breast cancer diagnosed at age 30 should be based on a comprehensive assessment of the individual's risk factors and preferences, in consultation with a healthcare provider.
From the Research
Breast Cancer Screening Recommendations
- Women with a maternal history of breast cancer at age 30 may need to consider earlier screening, as studies suggest that those with a first-degree family history of breast cancer are at higher risk 2, 3.
- The American College of Radiology (ACR) recommends annual screening beginning at age 40 for women of average risk, but earlier and/or more intensive screening for women at higher-than-average risk, including those with a family history of breast cancer 4.
- For women with a family history of breast cancer, initiating screening 5-8 years earlier than the relative's diagnosis age may be considered, in consultation with their provider 3.
- Breast MRI is recommended as an adjunct to annual mammography and clinical breast examination for women with a BRCA1 or BRCA2 mutation, or those with a first-degree relative who has a BRCA1 or BRCA2 mutation but who have not undergone genetic testing themselves 5, 6.
Screening Methods
- Mammography is the primary screening method for breast cancer, but breast MRI may be recommended as an adjunct for women at higher risk, including those with a family history of breast cancer 4, 6.
- Contrast-enhanced mammography or ultrasound may be considered for women who qualify for but cannot undergo breast MRI 4.
- Annual screening breast MRI is recommended for women with genetics-based increased risk, those with a calculated lifetime risk of 20% or more, and those exposed to chest radiation at young ages 4.
Risk Assessment
- All women should undergo risk assessment by age 25, especially Black women and women of Ashkenazi Jewish heritage, to identify those at higher-than-average risk and initiate appropriate screening 4.
- Women with a family history of breast cancer should discuss their individual risk factors and screening options with their provider to determine the best approach for their situation 2, 3.