Breast cancer screening for patients at higher-than-average risk

Breast cancer is the most common type of cancer diagnosed in women, excluding skin cancer. It is one of the leading causes of cancer-related deaths and premature deaths in the United States. Given the latest data on breast cancer prevalence, most clinical practice guidelines recommend yearly screening with mammography for women age 40 years and older. However, some women's lifetime risk of breast cancer may be higher than average, requiring additional testing and more intensive screening. Currently, no standard approach to office-based risk assessment has been established in the United States. A woman's unidentified heightened risk can lead to missed opportunities and insufficient screening recommendations. Breast cancer risk assessment is thus critical for identifying women who are at higher-than-average risk for breast cancer and in need of a modified screening plan. This article aims to guide clinicians through assessing a woman's lifetime risk of breast cancer, identifying women at higher-than-average risk, determining which women need to be referred for genetic testing, and managing screening and counseling for patients with nonhereditary higher-than-average risk.