Women at High Risk for Breast Cancer—What the Primary Care Provider Needs to Know

Nelia Afonso

doi:10.3122/jabfm.2009.01.070188

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Table 1.

Breast Cancer Screening for Women at Increased Risk

	Symptom Category	Screening Follow-up
NCCN guidelines^*	Prior thoracic RT	Periodic breast self-exam encouraged (<25 years old)
		Annual clinical breast exam (>25 years old)
		Annual mammogram (8–10 years after RT or 40 years, whichever first)
	5-year risk of invasive breast cancer ≥1.7%^{^†}	Periodic breast self-exam encouraged
		Clinical breast exam every 6 to 12 months (35 years old)
	Genetic high risk	Monthly self breast exam (18 years old)
		Bimonthly clinical breast exam (25 years old)
		Annual mammogram (20–25 years old)
		Annual MRI (25 years old)
ACS guidelines^{^‡}	<15% lifetime risk	MRI not recommended
	15% to 20% lifetime risk	Should talk with their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram.
	>20% lifetime risk	Annual mammogram and annual MRI
USPSTF^{^§}	Women who are at increased risk for breast cancer (for example, those with a family history of breast cancer in a mother or sister, a previous breast biopsy revealing atypical hyperplasia, or first childbirth after age 30)	More likely to benefit from regular mammography than women at lower risk. The recommendation for women to begin routine screening in their 40s is strengthened by a family history of breast cancer having been diagnosed before menopause.
	The USPSTF did not examine whether women should be screened for genetic mutations (BRCA1 and BRCA2) that increase the risk of developing breast cancer, or whether women with genetic mutations might benefit from earlier or more frequent screening for breast cancer.

* From National Comprehensive Cancer Network. Clinical practice guidelines in oncology, 2007. Available at http://www.nccn.org.
† Risk based on the breast cancer risk assessment tool.
‡ From Saslow D, Boetes C, Burke W, et al. American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin 2007;57:75–89.
§ From US Preventive Services Task Force. Screening for breast cancer: recommendations and rationale. Ann Intern Med 2002;137(5 Part 1):344–6.
RT, radiation therapy; MRI, magnetic resonance imaging.