Breast screening

Close surveillance or screening for cancer uses tests to try to catch cancer in its early stages, when it is most treatable. Surveillance doesn’t prevent cancer. However, early detection improves a person’s chance of surviving their cancer. Studies of breast cancer screening tools for high-risk women, some including women with BRCA mutations, found certain screening more likely to detect cancer. Whether close surveillance will lower the death rate from breast cancer in high-risk women is unknown. Nevertheless, based on these studies, recommendations for breast cancer screening in the high-risk population differ from recommendations for the general population.

In women with mutations in BRCA, PALB2, CHEK2, ATM, or other genes that increase cancer risk, breast cancer tends to occur at a younger age, and the lifetime risk for cancer is higher than the general population. Therefore, screening tests that might not be appropriate for women of average risk may be recommended for those in the high-risk category. As surveillance for breast cancer in high-risk women is further researched, screening recommendations will likely change. For the above reasons, it is important to consult with health care experts who are familiar with the standards of care and risk management in high-risk women. Further, it is important to understand that sweeping recommendations regarding cancer surveillance may not apply to women with increased risk for cancer.

The National Comprehensive Cancer Network (NCCN) is a consortium of cancer centers with experts in management of hereditary cancer.In general, NCCN guidelines dictate the standard of care for cancer surveillance in high-risk patients (including BRCA1, BRCA2, PALB2, NF1, NBN, ATM, CDH1, and CHEK2). These risk management guidelines are updated annually based on the latest research. Current NCCN guidelines for surveillance of high-risk women include:

• Learning to be aware of changes in breasts beginning at age 18
• Clinical breast exam every 6-12 months beginning at age 25
• Annual breast MRI and mammogram beginning at age 25-40 (the age to begin screening depends on the type of gene mutation and/or youngest age of breast cancer in the family)
• Consider 3D mammography
• Screening after age 75 should be considered on an individual basis

Updated 12/29/2016