Does a 34-year-old female patient with a first-degree relative (cousin) diagnosed with breast cancer require breast cancer screening?

From the Research

A 34-year-old female with a 38-year-old cousin diagnosed with breast cancer should follow standard breast cancer screening guidelines rather than early screening. Current recommendations for women at average risk suggest beginning annual mammograms at age 40 1. Having a single second-degree relative (cousin) with breast cancer, especially one diagnosed after age 35, does not significantly increase risk enough to warrant early screening. The patient should practice breast self-awareness and have clinical breast exams during regular check-ups. However, she should discuss her family history with her healthcare provider, who may recommend genetic counseling if there are additional concerning family history elements such as multiple affected relatives, early-onset cancers, male breast cancer, or Ashkenazi Jewish ancestry.

Some key points to consider in this patient's case include:

• The age of the cousin at diagnosis (38 years) and the degree of relation (second-degree) do not significantly increase the patient's risk enough to warrant early screening 2.
• Breast cancer risk assessment is complex and considers multiple factors beyond a single affected relative, including age at diagnosis, degree of relation, and pattern of cancer in the family 1.
• The USPSTF and AAFP recommend biennial screening mammography for average-risk women 50 to 74 years of age, but there is no strong evidence supporting a net benefit of mammography screening in average-risk women 40 to 49 years of age 1.
• Women at high risk of breast cancer may benefit from mammography starting at 30 years of age or earlier, with supplemental screening such as magnetic resonance imaging 3, 4.

Given the patient's age and family history, standard breast cancer screening guidelines are recommended, with no need for early screening. The patient should continue to practice breast self-awareness and have clinical breast exams during regular check-ups, and discuss her family history with her healthcare provider to determine if genetic counseling is necessary 1, 5.