Table 4.

The screening recommendations in high-risk women in eligible guidelines.

Risk factors	Guidelines	Screening age	Screening methods and intervals
Personal history of pre-cancerous lesions and/or breast cancer	NCCN, 2019 [18]	Form the time of diagnosis but no less than 30 for MAM and no less than 25 for MRI	■Breast awareness and clinical encounter: every 6–12 months; ■MAM: annual, with consideration of tomosynthesis; ■MRI: annual
	ACR (High-risk), 2017 [20]	From the time of diagnosis	MRI: annual
	ACR and SBI, 2010 [22]	From the time of diagnosis	■MAM: annual; ■Either MRI or US: annual
	MOH of Singapore, 2010 [30]	NR	MAM: annual [Grade D]
	MOH of Malaysia, 2019 [31]	40–59 years, 30–39 years (may be considered)	MAM: annual
		≥60 years	MAM: biennial
	NCC China, 2021 [32]	NR	MAM and US: annual
	CEWG, 2018 [33]	From 35 years	MAM: annual
	CBR, SBM, and FEBRASGO, 2017 [35]	From diagnosis onward	■MAM: annual [category C recommendation]; ■MRI: annual [category C recommendation]
Family history of breast cancer	NCCN, 2019 [18]	Begin at the age identified as being at increased risk	Breast awareness and clinical encounter: every 6–12 months
		Start from 10 years prior to the diagnosis of youngest family member but not less than 30	DM: annual, with consideration of tomosynthesis
		Begin 10 years prior to the diagnosis of youngest family member	MRI: annual
	ESMO, 2019 [8]	NR	MAM and MRI: annual (concomitant or alternating) [Ⅲ, A]
	NCC China, 2020 [32]	NR	MAM and US: annual
	CEWG, 2018 [33]	Begin at age 35 or 10 years prior to the age at diagnosis of the youngest-affected relative (for those with family history), whichever is earlier, but not earlier than age 30.	MAM: annual
Known genetic predisposition of breast cancer	ACR, 2017 [19]	NR	■MAM or DBT is recommended; ■MRI may be considered as an adjunct to MAM or DBT; ■US is recommended when the patient cannot tolerate MRI
	ACR (High-risk), 2017 [20]	30 years	DM+/DBT: annual
		25–30 years	MRI: annual
	ACR and SBI, 2010 [22]	Start by age 30 but not before age 25	MAM: annual
	EUSOMA, 2010 [26]	Start from 30 years; Before 30 years [discuss, mutation carrier of BRCA1 or BRCA2 (start from 25 to 29) and TP53 (start from 20)]	MRI: annual
	MOH of Singapore, 2010 [30]	Start at age 25–30 years for BRCA mutation carriers and their untested first-degree relatives, or as early as 5–10 years before the age of onset of breast cancer in the youngest family member in those with family history of breast cancer but no proven mutation	■BSE: monthly [Grade D]; ■CBE: 6 monthly [Grade D]; ■MAM and MRI: annual [Grade D]
	MOH of Malaysia, 2019 [31]	30–49 years	MRI: annual
		40–69 years	MAM: annual
		≥70 years	MAM: biennial
	NCC China, 2020 [32]	NR	MRI: annual
	CBR, SBM, and FEBRASGO, 2017 [35]	From 30 years	MAM annual [category B recommendation]
		From 25 years	MRI annual [category A recommendation]
History of mantle or chest radiation therapy	NCCN, 2019 [18]	Start from 10 years after radiation exposure	Breast awareness and clinical encounter: every 6–12 months
		Start from 10 years after radiation exposure but not less than age 30	DM: annual, with consideration of tomosynthesis
		Start from 10 years after radiation exposure but not less than age 25	MRI: annual
		Start from 10 years after radiation exposure for women younger than 25 years who have received prior thoracic irradiation	Breast awareness, counseling on risk and an annual clinical encounter
	ACR, 2017 [19]	Start from age 25 or 8 years after radiation therapy, whichever is later	MAM
	ACR (High-risk), 2017 [20]	Start from age 25 or 8 years after radiation therapy, whichever is later	DM+/DBT: annual
	NCC China, 2020 [32]	NR	MRI: annual
	CEWG, 2018 [33]	Begin at age 35	■MAM: annual; ■Consider MAM + MRI: annual
	CBR, SBM, and FEBRASGO, 2017 [35]	Start from the 8th year after radiotherapy onward, but not begin before age 30	MAM: annual [category C recommendation]
		Start from the 8th year after radiotherapy onward, but not begin before age 25	MRI: annual [category C recommendation]
Dense breasts	ACR, 2017 [19]	NR	Consider: US
	ACR (High-risk), 2017 [20]	NR	■MRI: annual; ■The addition of US to MAM may be useful
	ACR and SBI, 2010 [22]	NR	Consider: US as an adjunct to MAM
	China NCC, 2020 [32]	NR	MAM and US: annual
	CBR, SBM, and FEBRASGO, 2017 [35]	NR	Consider: US as an adjunct to MAM

Abbreviations: ACR: American College of Radiology; BRCA: Breast cancer gene; BSE: Breast Self-Examination; CBE: Clinical Breast Examination; CBR: Brazilian College of Radiology and Diagnostic Imaging; CEWG: Cancer Expert Working Group; DBT: Digital Breast Tomosynthesis; DM: Digital Mammography; ESMO: European Society for Medical Oncology; EUSOMA: European Society of Breast Cancer Specialists; FEBRASGO: Brazilian Federation of Gynecological and Obstetrical Associations; MAM: mammography; MOH: Ministry of Health; MRI: Magnetic Resonance Imaging; NCC: National Cancer Centre; NCCN: National Comprehensive Cancer Network; NR: No Recommendation; SBI: Society of Breast Imaging; SBM: Brazilian Society for Breast Disease; US: Ultrasound.