Breast cancer screening can be confusing, and even scary, but it shouldn’t be. Read on to learn more about your personal risk factors, when to start screening, and how the medical world defines “high-risk.”

The ACS recommends annual mammography and breast MRI starting at age 30 for females with a high risk of breast cancer.

It is important to note that breast MRI should be done in addition to, rather than instead of mammography, as each screening modality confers its own detection strengths and weaknesses.

ACR (American College of Radiology): recommends risk assessment at age 25 for Back and Ashkenazi Jewish women to assess if screening is needed before age 40.

The ACR’s most recent breast cancer guidelines have classified Black women and other minorities as high-risk compared to non-Hispanic white women. This is based on the following observations:

Prior to age 50, minority women are:  
127% more likely to die of breast cancer
72% more likely to be diagnosed with breast cancer
58% more likely to be diagnosed with advanced-stage breast cancer

Black women are 42% more likely to die from breast cancer despite roughly equal incidence rates.

Black women are less likely to be diagnosed with stage I breast cancer but twice as likely to die of early breast cancers.

Black women have a two-fold higher risk of aggressive breast tumors and a higher risk of BRCA1 and BRCA2 genetic mutations (placing them at higher risk).

“Since 1990, breast cancer death rates in Black women, who develop and die from the disease earlier, have only dropped approximately half as fast as in white women,” said Stamatia Destounis, MD, FACR, co-author of the new guidelines, chair of the American College of Radiology Breast Imaging Commission and managing partner at Elizabeth Wende Breast Care in Rochester, NY.

What makes someone high risk?

*BRCA1 or BRCA2 gene mutations (based on genetic testing)

*First degree relative (mom, dad, brother or sister) with BRCA1 or BRCA2 (have not had genetic testing themselves)

*Radiation to the chest before age 30

*Having Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome
(or having first-degree relatives with one of these syndromes)

*Having a lifetime breast cancer risk of 20-25% (determined by risk assessment tools below)

What is a risk assessment tool, and what does it look at?

Risk assessment tools are created based on the comparison of data from patients who have previously been diagnosed with breast cancer and should serve as a tool to increase the awareness of risk factors for breast cancer. Examples of commonly used risk assessment tools for breast cancer include- Gail, BRCAPRO, Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm, International Breast Cancer Intervention Studies (IBIS, also known as Tyrer–Cuzick), or the Claus model.

Risk factors for breast cancer include:

Age- risk increases with increasing age
Family history of breast CA in a first degree relative- increases your risk of breast CA
Race/Ethnicity- certain ethnic groups may be more prone to inheriting BRCA1/2 mutations
Breast Density- higher density breast tissue confers a higher risk of breast CA
Hormone Exposure- long term exposure to high levels or estrogen or progesterone
Age at 1^st Period- earlier age of onset confers a higher risk due to prolonged hormone exposure
Age at Menopause- later age of onset confers a higher risk due to prolonged hormone exposure
Childbirth history- people that have not given birth have had more periods and more hormone exposure

Not all risk factors are weighted equally. Awareness of your personal risk factors should guide the discussion of appropriate screening frequency and screening modalities between you and your healthcare provider. Additionally, many large health systems have dedicated, multi-disciplinary teams to help create personalized screening and treatment plans for patients with a high risk of breast cancer.

Please remember to get your screening and be sure to inform your doctor about any changes in your personal or family history that may impact your risk for breast cancer.

Sincerely,
Corsano MD- your friendly neighborhood PCP

Resources: American Cancer Society (ACS), American College of Obstetrics and Gynecology (ACOG), Cleveland Clinic, American College of Radiology
Image: Breast Cancer – Signs and Symptoms – Dr Lal PathLabs Blog