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Breast screening for women with a high risk of breast cancer

Updated 27 September 2024

Applies to England

What ‘high risk’ means

You have been assessed by a specialist in genetics or oncology as being at more risk of developing breast cancer than women in the general population. Women at high risk of breast cancer are offered breast screening at an earlier age than women from the general population. We call this ‘surveillance’ screening.

Surveillance screening

We will offer you screening more often than ‘routine’ screening, at least up until the age of 50. For some women, more frequent screening will continue. For others, they will then have routine breast screening which is every 3 years.

We will offer you MRI (magnetic resonance imaging) or mammography (breast x-rays), or possibly both. It will depend on your age, and the reason for your high risk of breast cancer. The genetics or oncology specialist will have already let you know what type of screening you can expect to have.

Methods of breast screening

There are 2 types of screening technology used for women at high risk.

MRI (magnetic resonance imaging)

The MRI scanner is a large tube surrounded by a strong magnetic field, with a platform bed that slides into it. For breast screening, you will be asked to lie face down on the bed. There are cushioned holes for your breasts, and a special rest for your head. MRI involves taking many different images of the breast, which may take a while. The whole imaging session usually lasts between 30 minutes and an hour.

During your MRI the doctor will give you a small injection in your arm. This contains a liquid (called a ‘contrast agent’) which helps different areas of breast tissue to show up on the scans. The liquid used with your MRI contains gadolinium. We know that small amounts of gadolinium may remain in the brain after a scan using a contrast agent. However, there is currently no evidence that these small amounts cause any harm. Gadolinium is essential for diagnosing a wide range of life-threatening diseases including breast cancer. If you need a scan using gadolinium, the doctor will use the lowest dose required for a clear image.

If you have any questions about your scan you can speak to the doctor.

Before MRI is carried out, screening staff will ask you some standard questions to ensure your safety. MRI is not suitable for everyone. The questions allow screening staff to decide if it is right for you.

MRI for breast screening is carried out at specialist centres, as both the equipment and screening staff must meet specific screening standards.

Mammography (X-rays of the breasts)

You can find out more about mammography in the information available with, or signposted from, your screening invitation. This information is available to all women invited to NHS breast screening. It includes an explanation of the possible benefits and disadvantages of screening. The information ‘NHS Breast Screening - helping you decide’ is available online.

Screening may not be suitable for everyone

There may be certain circumstances that mean screening cannot be carried out. If you have any concerns about whether you can be screened, please contact your local breast screening service.

You can find details of your local service using the NHS.UK location finder.

When you reach the routine screening age of 50

Some women are at high risk of breast cancer due to having altered genes (we call this a ‘gene mutation’). We will only continue to invite you for surveillance screening every year from age 50 if you have tested positive for a gene mutation. You can read more information about genetic testing.

Most women will continue to be screened every year. If you were previously screened using MRI and mammography, you may change to being screened using mammography only. This is because mammography is generally better at detecting breast cancers in older breast tissue. Some women will continue to have MRI as well as mammography. This will be decided by the clinician.

If you do not test positive for a gene mutation, we will automatically invite you for routine breast screening every 3 years. Women get their first routine screening invitation sometime between their 50th and 53rd birthdays.

When your breast screening invitations stop

All breast screening invitations stop at the age of 71. This includes if you have been having surveillance screening (every year), or routine screening (every 3 years).

You can continue to have screening from the age of 71 by contacting your local breast screening service to make an appointment. If you have been invited for:

• surveillance screening every year up to the age of 71, you can request an appointment every year
• routine screening every 3 years up to the age of 71, you can request an appointment every 3 years

You can find details of your local service using the NHS.UK location finder.

Changes to your breasts

No screening method can detect every cancer, and cancer can develop in between screening appointments.

If you notice any unusual changes in your breasts, please speak to your doctor (GP) as soon as possible. Do not wait for your next screening appointment.

Being breast aware

All women should be breast aware. This means knowing how your breasts normally look and feel, and reporting any unusual changes to your doctor as soon as possible. We advise following the ‘touch look check’ (TLC) 3 simple steps:

• TOUCH your breasts. Can you feel anything unusual?
• LOOK for changes. Is there any change in shape or texture?
• CHECK anything unusual with your doctor

(TLC information reproduced by permission of Breast Cancer Now.)

More information

The NHS website has more information about NHS breast screening.

Cancer Research UK has information about breast cancer risks, including family history and genetic risk.

The NHS screening programmes use personal information from your NHS records to invite you for screening at the right time. NHS England also uses your information to ensure you receive high quality care and to improve the screening programmes. Find out more about how your information is used and protected, and your options.

Read information about how to opt out of screening.