October is Breast Cancer Awareness Month. About 1 in 8 U.S. women will be diagnosed with breast cancer in her lifetime, and the American Cancer Society estimates more than 300,000 new cases of invasive breast cancer a year. For women at average risk, the current guideline is simple: a mammogram every two years from age 40 through 74. But some women need to start earlier or add other tests, and the first step is knowing your risk.
Your family history matters
The U.S. Preventive Services Task Force recommends that women with a personal or family history of breast, ovarian, tubal or peritoneal cancer, or with ancestry linked to BRCA1 or BRCA2 gene changes, have a brief risk assessment. If it points to higher risk, the next step is genetic counseling and, if appropriate, genetic testing. Women without those histories do not need routine genetic testing.
Before your visit, ask relatives about cancers on both sides of the family, including your father's side, which is easy to overlook, and the age at diagnosis.
Who counts as high risk
The American Cancer Society considers women high risk if they have:
- A lifetime risk of about 20 to 25 percent or more, estimated with a family history risk tool
- A known BRCA1 or BRCA2 gene change, or a parent, sibling or child with one if they have not been tested
- Radiation therapy to the chest before age 30
- Certain inherited syndromes, such as Li-Fraumeni or Cowden syndrome, in themselves or a first-degree relative
For these women, the Society recommends a breast MRI and a mammogram every year, typically starting at age 30. MRI is added to the mammogram, not used in its place.
Dense breasts
Mammogram reports now tell you whether your breast tissue is dense. Dense tissue makes cancer harder to see and slightly raises risk. If your report says dense, talk with your provider about your overall risk and whether more imaging makes sense for you.
Ready to Get Started?
Primary care, mental health, and addiction medicine in one practice. New patients are often able to be scheduled within a week of requesting an appointment.
Care from Hope Integrative Medicine
We can review your family history, order your mammogram and refer you for genetic counseling when it fits. We see adults in person at our West Ashley office and by telehealth across South Carolina, with primary care and mental health care in one practice. New patients are often able to be scheduled within a week of requesting an appointment. Request an appointment.
Sources: USPSTF, Breast Cancer: Screening; USPSTF, BRCA-Related Cancer: Risk Assessment, Genetic Counseling and Genetic Testing; American Cancer Society, Recommendations for the Early Detection of Breast Cancer; American Cancer Society, Key Statistics for Breast Cancer; FDA, breast density notification; National Cancer Institute, Breast Cancer Screening; Proclamation 6615, National Mammography Day.
This article is general health information and does not replace advice from your own provider.
Frequently Asked Questions
It depends on your overall risk. A risk assessment with your provider estimates it, and women at high risk may start yearly mammograms and MRI as early as age 30.
The Task Force recommends a risk assessment for women with a personal or family history of breast, ovarian, tubal or peritoneal cancer, or ancestry linked to BRCA changes, followed by genetic counseling and possibly testing if the assessment is positive.
Dense tissue is common. It can make cancer harder to see and slightly raises risk, so talk with your provider about your overall risk and whether other imaging makes sense.