Clinical Review Evidence based case report

Advice about mammography for a young woman with a family history of breast cancer

BMJ 2001; 322 doi: (Published 28 April 2001) Cite this as: BMJ 2001;322:1040
  1. Anneke Lucassen, consultanta (,
  2. Eila Watson, senior research officerb,
  3. Diana Eccles, consultanta
  1. a Wessex Regional Genetics Service, Princess Anne Hospital, Southampton SO16 5YA
  2. b CRC Primary Care Education Research Group, Department of Primary Health Care, University of Oxford Institute of Health Sciences, Oxford OX3 7LG
  1. Correspondence to: A Lucassen

    A 35 year old woman with a family history of breast cancer was in need of advice. Her two sisters, aged 34 and 38, were healthy and not affected, but her mother had developed breast cancer at the age of 48, and her mother's paternal aunt had developed it at 39 (figure). The sisters lived in different parts of the United Kingdom. Her elder sister had been told that this family history was not important and that she would not need any screening until she was eligible for the national screening programme, whereas her younger sister had already had a mammogram and been told that she should have these yearly from the age of 35. The patient was confused and asked her general practitioner whether she should have mammography. The general practitioner wrote to the local genetics service for advice.

    Summary points

    There have been no randomised controlled trials of mammography in women under 50 with a family history of breast cancer

    The sensitivity and specificity of mammography are lower in women aged under 50 than in those over 50

    There is no NHS funding for mammographic screening of women under 50 with a family history of breast cancer, although such screening is performed regularly

    The current consensus view is that mammography for women under 50 is appropriate if there is a certain degree of family history of breast cancer

    Guidelines for such screening are available locally through most clinical genetics departments

    An area of confusion

    Our experience with such enquiries suggested that the patient and her doctor were not alone in their confusion. Nationally and internationally, recommendations for screening women under 50 with a family history of breast cancer vary enormously. When family members are separated geographically they often receive different advice in both primary and secondary care. There is a plethora of local guidelines …

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