Family history of breast cancer

Breast screening uses mammograms (breast x-rays) to find breast cancers early. Currently, women under 50 are not routinely offered breast screening. This is because women under 50 have a low risk of breast cancer and mammograms are less effective at finding breast cancer in women who have not had their menopause. The menopause usually happens around the age of 50. Breast screening is sometimes offered to younger women if they have a strong family history of breast cancer.

If you think you may have an increased risk of developing breast cancer because of your family history, speak to your GP. They can refer you to a family history clinic for a risk assessment. A family history of breast cancer does not mean that you will develop it too. Most women with a family history of breast cancer do not ever develop breast cancer themselves.

Younger women with an increased risk of developing breast cancer are offered regular screening. This includes mammograms, digital mammograms and MRI scans.

What is breast screening?

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 (12.5%) will develop breast cancer at some time in their life. For most women, the biggest risk factor for developing breast cancer is increasing age. 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 to 70 are invited for breast screening every three years. Each country in the UK has its own screening programme. In England, the age range for breast screening is gradually extending to include women aged 47 to 73.

If you are 70 or over, you are not automatically invited for breast screening. But if you want to, you can make your own appointments for free mammograms (breast x-rays) every three years.

Why younger women are not usually screened

Younger women are not routinely offered breast screening through the NHS Breast Screening Programme in the UK. Large research trials have shown that regular screening for younger women is less effective than it is for older women.

Mammograms, which are used for screening, are less effective at finding breast cancer in women who have not reached the menopause. On average, the menopause happens around the age of 50. After menopause, the breast tissue is less dense. This makes mammograms easier to read, which makes the results more reliable.

Younger women who have an increased risk of breast cancer because of family history may be screened using MRI scanning or mammograms (see below). This will depend on their age and level of risk.


Family history and increased breast cancer risk

Most women with a family history of breast cancer are not in a high-risk group and do not ever develop breast cancer. Even if you are in a high-risk group, it does not 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. If it is appropriate, your GP can refer you to a family history clinic for assessment. If one of your relatives is having treatment for breast cancer, their doctor may advise you to go for screening.

The National Institute for Health and Care Excellence (NICE) is an independent body that gives advice about which treatments should be available on the NHS in England and Wales. NICE has developed guidelines on the screening of women with an increased risk of developing breast cancer because of their family history.

Risk assessment

To estimate your risk, a nurse or doctor at the family history clinic will talk to you about your family history. They may use questionnaires or computer programs as part of the assessment.

You will be asked about:

  • first-degree relatives with breast cancer – this means your parents, brothers, sisters and children
  • second-degree relatives with breast cancer – this means your grandparents, grandchildren, aunts, uncles, nieces, nephews, half-sisters and half-brothers.

They will ask about both your mother’s and your father’s sides of the family.

We have more information about cancer genetics that you may find helpful.

NICE guidelines group women into three risk groups:

  • average risk (near-population risk)
  • moderate risk
  • high risk.

The type of screening recommended will depend on your level of risk and your age.

Below are a few examples of what may be recommended for someone in each risk group. These are taken from NICE guidelines. It’s not a complete list and there may be other examples.

When we mention more than one relative, all of them must be on the same side of the family and must be blood relatives.

Average risk (near-population risk)

Your risk of developing breast cancer is similar to that of the general population.

If the risk assessment shows you have the same risk as the general population, you will be advised to have the usual screening through the NHS Breast Screening Programme.

Moderate risk

This 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 one first-degree and one 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 women have a high risk breast of cancer if they have 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 (at least one must be a first-degree relative).
  • Four relatives diagnosed with breast cancer at any age (at least 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 second-degree relative diagnosed with ovarian cancer at any age, and one first-degree or second-degree relative diagnosed with breast cancer before 50.
  • Two first-degree or second-degree relatives diagnosed with ovarian cancer at any age.

Fewer than 1 in 100 women (1%) are at a high risk of developing breast cancer because of their family history. If you are assessed as having a high risk, you may be offered a referral to a specialist genetics service. They will be able to do a more detailed assessment of a possible genetic link in the family.


Other factors that may influence family history breast cancer risk

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 on the same side of the family with breast and ovarian cancer
  • Jewish ancestry
  • a history of any rare or childhood cancers on the same side of the family.

You will be asked about factors like this during your assessment. It is 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

Your breast care team will talk to you about the most appropriate screening for you. This will depend on:

  • your level of risk
  • your age
  • what is right for your individual situation.

You will be given information about the screening methods that are used. You may be offered mammograms or an MRI scan.

It is important to check yourself for symptoms of breast cancer in between screening appointments. If you notice any changes to your breasts, you should get them checked.

Mammogram

A mammogram is a low-dose x-ray of the breast tissue. It tests for early breast cancer.

You will 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. Each breast is 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. You may find this uncomfortable, and for some women it is painful for a short time while the breast is being compressed. You will 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 mammogram

The standard way of taking mammograms uses x-ray images of the breast. Most modern mammogram equipment now takes digital images using a computer. 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 a mammogram because of an increased risk of breast cancer, are recommended to have a digital mammogram whenever possible.

MRI scan (magnetic resonance imaging scan)

MRI scans are used to screen some women who are under 50 and at very high risk of breast cancer.

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 is painless but can be uncomfortable, and some women feel a bit claustrophobic (afraid of small spaces) during the scan. It is also noisy, but you will 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. This is called a contrast medium. It can help the images from the scan to show up more clearly.


Back to Breast screening

Breast awareness

Knowing what your breasts normally feel and look like can help you to notice any changes early.