I'm 21 years old, and I want to know when I should start having breast exams. My grandmother, mother, and both of my aunts are breast cancer survivors. Today my sister was told she also has breast cancer. Do I need to get exams more frequently because of my family history?
This may be a good idea for you, but there are a number of factors to consider first. Because your history is highly suggestive of a familial, or genetic, predisposition to breast cancer, you should start by talking with your doctor about seeing a genetic counselor to discuss genetic testing. Ideally, one of your blood relatives who has had breast cancer will be tested first (just a blood test is required ) to determine whether one of the well-described genetic mutations, such as BRCA-1 or BRCA-2, is present. If a mutation is found, then other blood relatives, including you, can consider being tested as well to see whether anyone also carries the same mutation. If you decide to have the testing and do have a mutation, a genetic counselor will then explain that your lifetime risk of developing breast cancer is much higher than that of women in the general population. Such an increased risk merits special breast cancer screening.
In general, women who have never had breast cancer but carry a BRCA-1 or BRCA-2 mutation should start having mammograms earlier. As a rule of thumb, this means at least ten years before the age of the youngest family member who has had a breast cancer, or at age 30, whichever is younger. They are also offered breast MRI screenings approximately once a year, generally six months after the annual mammogram. Other options for carriers of BRCA-1 and BRCA-2 mutations include having elective surgery to remove breast tissue (called prophylactic mastectomy) and/or the ovaries (called prophylactic oophorectomy) to substantially decrease the lifetime risk of developing breast cancer.
If your blood relative has a BRCA-1 or BRCA-2 mutation but you are found NOT to have inherited it, your personal breast cancer risk is closer to that of the general population, despite your family history. In this case, recommendations for breast cancer screening would be in line with those for the general population (an annual mammogram, beginning at age 40).
In some families, many women are affected by breast cancer but are not found to have BRCA-1 or BRCA-2 mutations or any other currently "findable" predisposition mutations. In this situation — where a genetic risk is likely but not yet "findable" — it is generally recommended that a woman begin breast cancer mammography screening about ten years before the age at which her youngest blood relative with breast cancer was diagnosed. Data for the usefulness of MRI screening are more limited in such families. An experienced genetic counselor, however, can be very helpful in explaining the details of genetic testing and screening recommendations for high-risk families.
Learn more in the Everyday Health Breast Cancer Center.