Recommendations for Screening for Women at Higher-than-average Risk

Early detection decreases breast cancer deaths. For women of average risk, the American College of Radiology / Society of Breast Imaging recommends annual screening mammography starting at age 40. Women at higher-than-average risk should, in general, start surveillance with mammography at an earlier age and consider supplemental screening as well.

Population Subgroups at Higher-Than-Average-Risk

Multiple factors increase risk for breast cancer: genetic mutations, family history, chest radiation at a young age, personal history of breast cancer or high-risk lesions, breast density, and race/ethnicity. Genetic abnormalities are found in only 5% to 10% of breast cancers, with BRCA mutations the most recognized. The lifetime breast cancer risk is 72% among BRCA1 carriers and 69% among BRCA2 carriers. All women should undergo risk assessment by age 25, especially Black women (who are at risk for breast cancers at a younger age) and women of Ashkenazi Jewish heritage, so that those at higher-than-average risk can be identified and appropriate screening initiated.

For most women at higher-than-average risk (>20% Lifetime Risk), the supplemental screening method of choice is breast MRI. An online patient calculator is available at For women with dense breasts who desire supplemental screening, breast MRI is recommended. For those who qualify for but cannot undergo breast MRI, contrast-enhanced mammography or screening breast ultrasound could be considered

Boutique Breast Imaging offers all patients Myriad’s myGeneHistory breast cancer risk assessment with correlation to patient’s personal breast tissue density on the mammogram to calculate each individual patient’s Lifetime Risk for breast cancer. With this information, we recommend personalized screening recommendations to each individual patient, including genetic testing (saliva test), offered in our office, if recommended (the genetic test is covered by insurance in 90% of patients, otherwise $249 out-of-pocket price).

If a patient calculates to be higher than 20% Lifetime Risk for breast cancer, recommendations for supplemental screening will include high risk screening breast MRI, staggered 6 months from the annual mammogram. Others with intermediate risk for breast cancer (15-20% Lifetime Risk) or dense breast tissue may undergo supplemental screening with Abbreviated Breast MRI or Breast Screening Ultrasound, performed by the breast radiologist in addition to the breast ultrasound technologist. Call (904) 901-0110 or schedule your screening mammogram here.


    • Breast Cancer Screening for Women at Higher-Than-Average Risk: Updated Recommendations From the ACR, Debra A L. Monticciolo MD, Mary S. Newell MD, Linda Moy MD, Cindy S. Lee MD, Stamatia V. Destounis MD , Journal of the American College of Radiology, Volume 20, Issue 9, September 2023, Pages 902-914. 

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