Study: Should biannual MRIs replace annual mammograms in high-risk women?

The National Comprehensive Cancer Network (NCCN) provides breast cancer risk-management guidelines for people with BRCA1 and BRCA2 mutations. We recommend that you speak with a genetics expert who can review your personal and family history of cancer and help you to determine the best risk management plan. Note that our use of "men" and "women" refers to the sex you were assigned at birth.

Recommended screening for women with BRCA mutations:

• Beginning at age 18, be aware of how your breasts normally look and feel. Tell your doctor about any breast changes.
• Beginning at age 25, have a doctor examine your breasts every 6-12 months.
• Beginning at age 25, have an annual breast MRI with contrast (or mammogram if MRI is unavailable).
• Beginning at age 30 and continuing until age 75, have an annual mammogram and an annual breast MRI with contrast.
• After age 75, speak with your doctor about the benefits and risks of screening.

Risk reduction for women:

• Speak with your doctor about the advantages and disadvantages of risk-reducing mastectomy.
  • Research shows that risk-reducing mastectomy can lower the chance of developing breast cancer in high-risk women by about 90 percent. Mastectomy has not been shown to help high-risk women live longer.
  • Because some breast tissue remains after mastectomy, some breast cancer risk also remains. 
• Speak with your doctor about the benefits and risks of tamoxifen or other estrogen-blocking drugs to reduce your breast cancer risk. The benefits and risks may be different for women with BRCA1 or BRCA2 mutations. Research on the benefit of these drugs to reduce breast cancer risk in women with BRCA1 mutations has been mixed.

Risk management for men:

• Beginning at age 35, learn how to do breast self-exams to check for breast changes.
• Beginning at age 35, have a doctor examine your chest every 12 months.
• Beginning at age 50, consider an annual mammogram (especially for men with BRCA2 mutations). 

Updated: 06/21/2024

The National Comprehensive Cancer Network (NCCN) provides guidelines for management of breast cancer risk in people with inherited mutations linked to breast cancer. We recommend that you speak with a genetics expert who can look at your personal and family history of cancer and help you determine the best risk management plan. 

ATM or CHEK2

• Beginning at age 40 (or earlier based on your family history of breast cancer)
  • recommend yearly mammogram
• Beginning at age 30-35
  • consider yearly MRI with and without contrast

BARD1, RAD51C or RAD51D 

• Beginning at age 40 (or earlier based on family history):
  • recommend yearly mammogram
  • consider yearly breast MRI with and without contrast

BRIP1

• No specific breast cancer screening guidelines. Risk management should be based on your family history of cancer.

CDH1 

• Beginning at age 30 (or earlier based on family history):
  • recommend yearly mammogram
  • consider yearly breast MRI with contrast
  • discuss risk-reducing mastectomy

PALB2

• Beginning at age 30 (or earlier based on family history):
  • recommend yearly mammogram
  • recommend yearly breast MRI with and without contrast
  • discuss risk-reducing mastectomy with your doctor

PTEN

• Beginning at age 18, learn to be aware of changes in breasts.
• Beginning at age 25:
  • clinical breast exam every 6-12 months beginning at age 25 or 10 years earlier than the youngest age of onset in the family
• Beginning at age 30:
  • yearly mammography and breast MRI with contrast beginning at age 30 or earlier based on the youngest breast cancer in the family
  • discuss risk-reducing mastectomy with your doctor
• After age 75
  • discuss benefits and limitations of continued screening with your doctor

STK11

• Beginning at age 30:
  • clinical breast examination by a health care provider every 6 months starting at age 30
  • recommend yearly mammogram
  • recommend yearly MRI with and without contrast
  • discuss risk-reducing mastectomy with your doctor

TP53

• Beginning at age 18, learn to be aware of changes in your breasts.
• Beginning at age 20:
  • clinical breast examination by a healthcare provider every 6 months
  • recommend yearly breast MRI with and without contrast beginning at age 20 or at the age of earliest breast cancer diagnosis if there is a history of breast cancer before age 20 in family
• Beginning at age 30
  • recommend yearly mammogram
• Consider risk reducing mastectomy.
• After age 75
  • discuss benefits and limitations of continued screening with your doctor

Updated: 12/17/2023

The National Comprehensive Cancer Network (NCCN) establishes guidelines for women with increased risk (a lifetime risk for breast cancer of 20 percent or more). The guidelines recommend the following screening:

• Have clinical exams every 6–12 months, starting when you are identified as being at increased risk, but not before age 21.
• Consider consulting with a genetic counselor or similarly trained health care provider, if you haven’t already done so.
• Consider consulting with a breast surgeon.
• Start annual mammography screening at age 40 or 10 years earlier than the age of the youngest family member who has been diagnosed with breast cancer, but not before age 30. Consider getting a 3D mammogram.
• Begin annual breast MRI at age 40 or 10 years earlier than the age of the youngest family member who has been diagnosed with breast cancer, but not before age 25.
• Consider recommended risk reduction strategies, such as preventive hormonal medications.
• Develop breast awareness and report any changes to your health care providers.

NCCN has separate guidelines for breast screening in women with an inherited mutation. See our gene-by-gene listing to find specific risk-management guidelines for people with an inherited mutation linked to cancer.  

Updated: 03/28/2022