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Breast Cancer Screening Family History

For People At Moderate Risk

Breast Cancer – Family history and screening.

People at moderate risk are likely to be offered regular breast screening. Screening for woman at moderate risk is offered from the age of 40, which is earlier than routine breast screening.

Your specialist team may also discuss with you the possibility of drug treatments to reduce the risk of breast cancer.

You can read more about these options in our booklet Family history of breast cancer: managing your risk.

Its important to go back to your GP if your family history changes, for example if another relative develops breast cancer or ovarian cancer.

Information Youll Be Asked At Your Appointment

At the appointment youll be asked about any type of cancer in all your blood relatives on both sides of your family.

This includes your mother and father, sons and daughters, brothers and sisters, aunts and uncles, nieces and nephews, cousins, grandparents, great uncles and great aunts.

Youll be asked about:

  • Your known family history on your mothers and fathers sides, including family members who have not had cancer, and the age at which any of them died
  • How the people diagnosed with cancer are related to you
  • How the people diagnosed with cancer are related to each other
  • What type of cancer each person had
  • How old each person was when diagnosed
  • Whether the same person has had more than one cancer
  • Your ethnic background
  • Your own breast cancer diagnosis if you have been diagnosed

If you dont have information about your family history or your blood relatives, your risk assessment can only be based on whatever information you have.

Category : Potentially High Risk

Less than 1% of women are in this group.

Women in this group have a family history of breast cancer or ovarian cancer occurring in:

  • Two first- or second-degree relatives on the same side of the family, plus

One or more of the following features:

  • Additional relatives with breast cancer or ovarian cancer
  • A relative with both breast and ovarian cancer
  • Breast cancer diagnosed before the age of 40
  • Breast cancer affecting both breasts
  • Ashkenazi Jewish ancestry
  • Breast cancer in a male relative
  • A relative who has tested positive for a high-risk gene mutation e.g. a mutation in genes such as

The risk of developing breast cancer in this group is potentially higher than that of the general population.

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Who Has Breast Screening

Each year more than 2 million women have breast cancer screening in the UK. The NHS Breast Screening Programme invites all women from the age of 50 to 70 for screening every 3 years. This means that some people may not have their first screening mammogram until they are 52 or 53 years.

In some parts of England, the screening programme has been inviting women from 47 to 73 years old as part of a trial.

If you are older than 70, you can still have screening every 3 years but you won’t automatically be invited. To make an appointment, talk to your GP or your local breast screening unit.

If you are younger than 50, your risk of breast cancer is generally very low. Mammograms are more difficult to read in younger women because their breast tissue is denser. So the patterns on the mammogram don’t show up as well. There is little evidence to show that regular mammograms for women below the screening age would reduce deaths from breast cancer.

Breast screening is also for some trans or non-binary people. Talk to your GP or Gender Identity Clinic about this.

American Cancer Society Screening Recommendations For Women At Average Breast Cancer Risk

When To Start Breast Cancer Screening With Family History

The COVID-19 pandemic has resulted in many non-emergency procedures being put on hold. This has led to a substantial decline in cancer screening. Health care facilities are providing cancer screening during the pandemic with many safety precautions in place. Learn how you can talk to your doctor and what steps you can take to plan, schedule, and get your regular cancer screenings in Cancer Screening During the COVID-19 Pandemic.

These guidelines are for women at average risk for breast cancer. For screening purposes, a woman is considered to be at average risk if she doesnt have a personal history of breast cancer, a strong family history of breast cancer, or a genetic mutation known to increase risk of breast cancer , and has not had chest radiation therapy before the age of 30.

  • Women between 40 and 44 have the option to start screening with a mammogram every year.
  • Women 45 to 54 should get mammograms every year.
  • Women 55 and older can switch to a mammogram every other year, or they can choose to continue yearly mammograms. Screening should continue as long as a woman is in good health and is expected to live at least 10 more years.
  • All women should understand what to expect when getting a mammogram for breast cancer screening what the test can and cannot do.

Clinical breast exams are not recommended for breast cancer screening among average-risk women at any age.

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Study Population & Outcome Variables

The study assessed breast cancer screening adherence and CRC screening adherence separately. The breast cancer screening population was defined as women aged 40-64 years old with no personal history of breast cancer or ovarian cancer, and who received a mammogram within the past 2 years . We included ovarian cancer in the family history of breast cancer group because a family history of ovarian cancer may also increase a woman’s risk of breast cancer.25 Studies on breast cancer screening behavior have included a family history of ovarian cancer as a risk factor for breast cancer risk.17, 26

The colorectal cancer screening population was defined as adults aged 50-64 years old with no personal history of colon cancer, who received a fecal occult blood test the past year, a sigmoidoscopy within the past 5 years, or a colonoscopy within the past 10 years . We could not identify individuals with a personal history of rectal cancer from the CHIS public use data, so only personal history of colon cancer was excluded. For both analyses, the lower age limits were based on the U.S. Preventive Services Task Force guidelines for routine breast and CRC screening at the time the CHIS data was collected in 2005, prior to the recent changes in the mammogram guideline recommendations in 2009.2729

What Happens If My Test Is Positive For Hereditary Breast Cancer Risk

If testing confirms you are at risk, your care provider can work with you on a plan to safeguard your health, which could include:

  • High-risk evaluation and monitoring
  • Screening schedules, including digital mammography and clinical breast exams
  • Hormonal therapy medications designed to prevent the development of breast cancer

Preventive surgery, such as mastectomy with breast reconstruction, is necessary only for patients at very high risk for aggressive breast cancer.

A comprehensive breast center offers a safe and supportive environment where you can ask questions and get the best answers for you, Ninan says. Every patients decision about how to handle their risk of developing breast cancer is managed with sensitivity and an understanding about the complexity of these decisions.

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What Else Should I Do

If you are concerned about your family history of breast cancer, you should discuss your individual circumstances with your family doctor. If there are any new cases of breast cancer diagnosed in your family since your last mammogram it is important that you inform both BreastScreen WA and your GP.

Information about Family History of breast cancer is also available in 32 languages other than English.

Family History Of Breast Cancer And Inherited Genes

Breast Cancer Screening With A Positive Family History

Some people have a higher risk of developing breast cancer than the general population because other members of their family have had particular cancers. This is called a family history of cancer.

Having a mother, sister or daughter diagnosed with breast cancer approximately doubles the risk of breast cancer. This risk is higher when more close relatives have breast cancer, or if a relative developed breast cancer under the age of 50. But most women who have a close relative with breast cancer will never develop it.

UK guidelines help GPs to identify people who might have an increased risk of cancer due to their family history.

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If You Are Called Back

Around 4 out of 100 women are called back for more tests. If this happens, you might feel very worried. But many of these women wont have cancer.

If you are called back because your mammogram showed an abnormal area, you might have a magnified mammogram. This can show up particular areas of the breasts more clearly. These mammograms show the borders of any lump or thickened area. They can also show up areas of calcium .

You might also have an ultrasound scan of the breast or a test to take a sample of cells from the abnormal area

Risk Stratification By Family History Of Cancer

We categorized family history of either cancers as average-risk or above average based on an algorithm developed by Scheuner et al. 1997.30 This risk stratification algorithm is suitable for our data and our analysis as it employs both first and second-degree relative information and does not require clinical information typically absent in health surveys. Average-risk individuals were those with no family history of cancer or only one second-degree relative diagnosed at any age. Above average-risk of family history was defined otherwise. We initially classified the above average-risk category into âModerateâ and âHighâ risk, but due to sample size limitations, these two risk groups were combined in the study analyses. Screening rates for the moderate and high-risk groups were not statistically different .

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Breast Cancer Screening For Women With A Strong Family History Of Breast Or Ovarian Cancer

There are special breast cancer screening guidelines for women with a strong family history of breast or ovarian cancer.

If you have a greater than 20 percent lifetime risk of breast cancer based mainly on your family history of breast or ovarian cancer, the National Comprehensive Cancer Network recommends you get a :

  • Clinical breast exam every 6-12 months, but not before age 21
  • Mammogram every year, starting at age 40 or starting 10 years younger than the youngest breast cancer case in your family
  • Breast MRI every year, starting at age 40 or starting 10 years younger than the youngest breast cancer case in your family

Learn more about breast cancer screening recommendations for women at higher risk.

Breast And Ovarian Cancer And Family History Risk Categories

Breast Cancer Screening Guidelines If Family History

This table provides examples of average, moderate, and strong family health histories of breast and ovarian cancer. This may help you understand if you have an increased risk for these cancers based on your family health history.

Note: This table does not include all possible family health histories of breast and ovarian cancer. If you have concerns about your family health history of breast or ovarian cancer, please talk to your doctor. Your doctor may assess your risk based on your personal and family health history, using one of the following:

Results may vary, depending on the tool used, and may differ from the risk categories below, which are based largely on the guidelines from the National Comprehensive Cancer Network.1

Family History Risk Category

Average: Typically not increased risk, similar to the general population risk

Average: Typically not increased risk, similar to the general population risk

No first or second-degree relatives with breast or ovarian cancer

or

One second-degree female relative with breast cancer diagnosed after age 50

No first or second-degree relatives with breast or ovarian cancer

or

One second-degree female relative with breast cancer diagnosed after age 50

Grandmother with breast cancer diagnosed at age 75

Grandmother with breast cancer diagnosed at age 75

Genetic counseling and testing for hereditary breast and ovarian cancer is not typically recommended for this type of family

oror

One first or second-degree relative with:

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Estimate Of Magnitude Of Net Benefit

Digital breast tomosynthesis is an emerging technology for breast cancer screening. Preliminary evidence suggests that it can reduce recall rates for false-positive results and detect more cancer compared with conventional digital mammography. However, it may increase breast biopsy rates, and as currently practiced in most settings, DBT exposes women to more radiation than conventional 2-dimensional mammography. It is not clear whether all of the extra cancer cases detected by DBT actually represent a benefit . Most importantly, no studies assessed the effect of DBT on important health outcomes for women, such as quality of life, morbidity, or mortality. Finally, increased breast density is a common condition that imparts some increased risk for breast cancer, and it reduces the test performance characteristics of mammography as well. Current evidence on the use of adjunctive screening in women with increased breast density is not sufficient to recommend a specific screening strategy. These are important areas for future research.

What Do I Do If I Am Concerned About My Family History

If you are worried about your family history of breast or ovarian cancer you should speak to your doctor.

If any new cases of breast cancer or ovarian cancer have been diagnosed in your family since your last mammogram it is important to tell your doctor and/or BreastScreen NSW.

BreastScreen NSW collects your family history information each time you attend for a mammogram. It is important to tell BreastScreen NSW if this information changes.

  • Monday, April 6, 2020 11:45 AM

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Outside The Screening Population

High risk screening population: women ages 30 to 69

Women 70 to 74 years of age identified as high risk should be screened every year with mammography only at any Ontario Breast Screening Program site.

Women over age 74 can be screened within the Ontario Breast Screening Program however, they are encouraged to make a personal decision about breast cancer screening in consultation with their healthcare provider. The Ontario Breast Screening Program will not recall women over age 74 to participate in the program. To continue screening through the OBSP, a referral is required from a womans healthcare provider.

For People At General Population Risk

Breast Cancer and Family History

If youre told youre at general population risk, you should be given information about routine breast screening. In the UK, women aged 50 to their 71st birthday are invited for a mammogram every three years.

You should also be told about the importance of being breast aware and reporting any possible signs of breast cancer.

Its important to go back to your GP if your family history changes for example if another relative develops breast or ovarian cancer.

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Understanding Your Own Level Of Risk Allows You To Be Appropriately Monitored For Breast Cancer

Most women are not in a high-risk group and dont ever develop breast cancer. However, understanding your own level of risk allows you to be properly monitored for breast cancer. Risk can be divided into three categories, and you might move into different categories throughout your life, or if your family history alters.

What Is A Family Member With More Than One Cancer

One family member who has more than one type of cancer. A family member who has cancer not typical for that gender, such as breast cancer in a male. Certain combinations of cancer, such as the combination of breast cancer with ovarian cancer, uterine cancer, colon cancer, prostate cancer, pancreatic cancer, or melanoma.

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What Is Breast Screening

Cancer screening involves testing apparently healthy people for signs that could show that a cancer is developing.

Breast screening uses a test called mammography which involves taking x-rays of the breasts. Screening can help to find breast cancers early when they are too small to see or feel. These tiny breast cancers are usually easier to treat than larger ones.

It is important to remember that screening will not prevent you from getting breast cancer but aims to find early breast cancers.

Overall, the breast screening programme finds cancer in around 9 out of every 1,000 women having screening.

Accuracy Of Screening Tests

Breast Cancer Screening Guidelines in the United States

All available RCTs evaluating the effectiveness of breast cancer screening used film mammography. Despite a lack of direct evidence of effectiveness in reducing breast cancer deaths, conventional digital mammography has essentially replaced film mammography as the primary method for breast cancer screening in the United States. Conventional digital screening mammography has been shown to have about the same diagnostic accuracy as film, although digital screening seems to have comparatively higher sensitivity in women younger than age 50 years.34 Across all ages, screening mammography has a sensitivity of approximately 77% to 95% and a specificity of about 94% to 97%.35

Digital breast tomosynthesis is an emerging technology. One study on the test characteristics of DBT as a primary breast cancer screening strategy met the minimum inclusion criteria of the systematic evidence review . As such, estimates of its test performance are subject to change with additional research. However, the positive predictive value of DBT ranges from 4.6% to 10.1% in U.S. studies.13

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I Have Had Breast Cancerwhat Does This Mean For My Daughter

Many women who have had breast cancer are concerned about the risk that this diagnosis carries for their daughters. You can estimate your daughters risk of breast cancer using the information in this brochure to determine her risk category. She may be above the average risk if you were diagnosed with breast cancer before the age of 50, or if a number of your relatives have developed breast or ovarian cancer.

Your daughter should speak to her doctor in more detail about her individual risk. It is possible that mammograms every year rather than every two years will be recommended. She may need to start having mammograms at an age younger than 40-50, depending on how old you were when your breast cancer was diagnosed. Starting regular breast x-rays 5-10 years before your age at diagnosis is a useful rule of thumb. Finally, if the family history is stronger, the doctor may suggest a referral to a family cancer clinic.

Westmead Breast Cancer Institute 8890 6728

Westmead Hospital Familial Cancer Service 8890 6947

Cancer Council Cancer Helpline 13 11 20

BreastScreen Australia 13 20 50

NSW Genetics Education Program 9926 7324

If you are in a country area, the services above will help you find your closest family cancer clinic.

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