Breast screening under 50

Breast screening Back to top

Breast screening is a way of finding breast cancers| early, when they are too small for you or your doctor to see or feel.

In the UK, around 1 in 8 women will develop breast cancer at some time in their life. For most women, increasing age is the greatest risk factor for developing breast cancer. This is one reason why breast screening begins at 50 for most women in the UK.

NHS Breast Screening Programme

In the UK, women aged 50-70 are invited to attend breast screening every three years as part of the NHS Breast Screening Programme (NHSBSP). Each country within the UK has its own screening programme. In England, the age range for breast screening is being extended to 47–73 by the end of 2016. 

If you are 70 or over, you're not automatically invited for breast screening. But you can make your own appointments| for free mammograms (breast x-ray) every three years if you wish. 

Why younger women are not usually screened

Large research trials have shown that regular screening for younger women is generally less effective than it is for older women. Because of this, younger women aren’t routinely offered breast screening on the NHS Breast Screening Programme in the UK.

One main reason for this is that mammograms (breast x-rays), which are used for screening, are less effective at detecting breast cancer in women who haven’t reached menopause.  The menopause happens, on average, around the age of 50.

After menopause the breast tissue is less dense, which makes mammograms easier to read and the results more reliable.

Younger women that have an increased risk of breast cancer because of family history are generally offered screening with a newer type of mammogram called a digital mammogram. This is better at detecting changes in denser breast tissue (see section on mammography).

Most women with a family history of breast cancer are not in a high-risk group and don’t ever develop breast cancer. Even if you are in a high-risk group, it doesn’t mean that you will develop breast cancer.

If you think you may be at increased risk of breast cancer because of your family history, talk to your GP about this. Your GP can refer you to a breast clinic for an assessment. Some women with a relative having treatment for breast cancer may be advised to come for screening by their relative’s consultant. 

The National Institute for Health and Clinical Excellence (NICE|) is an independent body that advises doctors on health prevention and treating certain conditions. NICE has developed guidelines on the screening of women with an increased risk of developing breast cancer because of their family history.

To estimate your risk, a nurse or doctor at the clinic will talk to you about your family history. They may use questionnaires or computer programs as part of your assessment. NICE guidelines group women into either moderate risk or high risk. The type of screening recommended will depend on your level of risk. If risk assessment shows you have the same risk as the average population, you’ll be advised to have the usual screening through the NHS breast screening programme.

At your assessment you’ll be asked about:

There’s more information about this in our section on cancer genetics|.

The following lists are only some examples taken from NICE guidelines so they’re not exhaustive. 

Where more than one relative is mentioned, all relatives must be on the same side of the family and must be blood relatives. 

Moderate risk

NICE guidelines say that moderate-risk breast cancer includes women with one of the following in their family history:

• One first-degree relative diagnosed with breast cancer before the age of 40.
• Two first-degree or second-degree relatives diagnosed with breast cancer at an average age of over 50.
• Three first-degree or second-degree relatives diagnosed with breast cancer at an average age of over 60.

High risk

NICE guidelines say that high-risk breast cancer includes women with one of the following in their family history:

• Two first-degree or second-degree relatives diagnosed with breast cancer before an average age of 50 (at least one must be a first-degree relative).
• Three first-degree or second-degree relatives diagnosed with breast cancer before an average age of 60 (one must be a first-degree relative).
• Four relatives diagnosed with breast cancer at any age (one must be a first-degree relative).
• One first-degree relative with cancer in both breasts, where the first cancer was diagnosed before 50.
• One first-degree or one second-degree relative diagnosed with ovarian cancer at any age, and one first or second-degree relative diagnosed with breast cancer before 50.
• Two first- or second-degree relatives diagnosed with ovarian cancer at any age.

Fewer than 1 in 100 women are at high risk of developing breast cancer because of their family history. If you’re assessed as having a high risk, you’ll be offered a referral to a specialist genetics service. This means you can have a more detailed assessment about a possible genetic link in the family.

Other factors that may influence family history breast cancer risk Back to top

There are other factors that may influence your risk of familial breast cancer.  

For example, if you have:

•  a close relative who has had breast cancer diagnosed in both breasts
•  a male relative with breast cancer
•  relatives with breast and ovarian cancer on the same side of the family
•  Jewish ancestry
•  a history of any rare or childhood cancers on the same side of the family.

You'll be asked about factors like this in your family during your consultation. It's also important to let your breast care team know if there are any changes in your family history as time goes on, as this may change your risk assessment. 

Screening methods for younger women at moderate or high risk Back to top

Your breast care team will talk to you about the most appropriate screening for your individual needs. This will depend on your level of risk, how old you are and what is right for your individual situation. You will be given information about the screening methods that are used.

You may be offered mammograms, MRI, or a combination of both.

Mammography

This is the most commonly used test for screening. A mammogram| is a low-dose x-ray of the breast| tissue. It tests for early breast cancer. You'll need to remove your clothes from the top part of your body, including your bra. The radiographer will then position you so that each breast, in turn, is placed on the x-ray machine and gently but firmly compressed (squashed) against a flat, clear, plastic plate. The breast tissue needs to be compressed to keep the breast still, and to get the clearest picture with the lowest amount of radiation possible. Most women find this uncomfortable, and for some women it is painful for a short time while the breast is being compressed. You'll need to stay still for less than a minute while the picture is being taken. Usually two mammograms are taken of each breast from different angles.

Digital mammography

The standard way of taking mammograms uses x-ray images of the breast.  A newer technique called digital mammography uses computer imaging. Studies have shown that digital mammograms are better at finding cancers in younger women and women who have denser breast tissue. 

Women under 50, who are having mammography because of an increased risk of breast cancer, are recommended to have digital mammography whenever possible.

MRI (magnetic resonance imaging)

MRI scanning is used for screening some women who are under 50 and at very high risk.

MRI scans use magnetism instead of x rays to build up a detailed picture of the breasts. During the scan, you'll be asked to lie very still on a couch inside a long tube for about 30 minutes. It's painless but can be uncomfortable, and some women feel a bit claustrophobic during the scan. It's also noisy, but you'll be given earplugs or headphones.

Some women are given an injection of dye into a vein in the arm, but this does not usually cause any discomfort.

Breast screening for women under 50 at increased risk Back to top

NICE guidelines recommend women with a moderate or high risk of breast cancer because of family history:

• should be offered yearly mammograms between the ages of 40–49
• should only be offered a mammogram between the ages of 30–39, as part of a research study or when they can be closely monitored
• may be offered a yearly MRI scan between the ages of 20–49, if they have a very high risk (this includes women with a faulty breast cancer gene).

After 50, most women are usually offered a mammogram every three years as part of the NHS breast screening programme. This is because breast cancer is easier to find in women over 50, and breast cancers are usually slower-growing in this age group. For women over 50, MRI scans are not routinely widely available for breast cancer screening.

There are plans to include screening for women at increased risk because of family history in the NHS breast screening programme. Because of this and results of the FH01 study,  screening advice for women in this group may change. Another study called the FH02 is looking at screening for women aged 35-39 with a family history of breast cancer.

If you're worried about your risk of breast cancer, you can use our online tool OPERA|, where you answer questions about your family history and print out a personal assessment. If a risk is identified, you can take the print-out to your GP.

Your feelings Back to top

It's difficult to face any uncertainty about your health. Making decisions about screening can be difficult and you may feel anxious| or frightened. Your breast care team will be able to support you, and specialist counsellors are available in some centres. Our cancer support specialists| can also give you details of helpful organisations| throughout the UK.