Breast Cancer Screening Recommendations in Hong Kong

Summary of CEWG recommendations on breast cancer screening for women at different risk profiles

Risk Category	Recommendation on Screening
Women at high risk Confirmed carriers of BRCA1 or BRCA2 gene mutations With strong family history of breast cancer or ovarian cancer With personal risk factors, such as history of radiation therapy to the chest for treatment between age 10 and 30 years, history of breast cancer, etc.	Seek advice from doctors; and Have mammography screening every year; Begin screening at age 35 or 10 years prior to the age at diagnosis of the youngest relative affected by breast or ovarian cancer (for those with family history), whichever is earlier, but not earlier than age 30 For confirmed carriers of BRCA1/2 gene mutations or women who had radiation therapy to chest for treatment between age 10 and 30 years (e.g. for Hodgkin’s disease), consider additional annual screening by magnetic resonance imaging
Women at moderate risk With family history of only one first-degree female relative with breast cancer diagnosed at ≤50 years of age; or two first-degree female relatives diagnosed with breast cancer after the age of 50 years	Have mammography every two years
Other women at general population Women aged 44 to 69 with certain combinations of personalised risk factors putting them at increased risk of breast cancer	Use the Breast Cancer Risk Assessment Tool for estimating the risk of developing breast cancer, and follow the screening recommendation of the Assessment Tool

Based on the available international and local scientific evidence, the Government’s Cancer Expert Working Group on Cancer Prevention and Screening (CEWG) recommends to adopt a risk-based approach for breast cancer screening and makes the recommendations for women at different risk profiles as follows:

(A) For women at high risk keyboard_arrow_down

Local definition – with any one of the risk factors:

Carriers of BRCA1/2 deleterious mutations confirmed by genetic testing.
Family history of breast cancer /ovarian cancer, such as
- any first-degree female relative is a confirmed carrier of BRCA1/2 deleterious mutations
- any first- or second-degree female relative with both breast cancer and ovarian cancer
- any first-degree female relative with bilateral breast cancer
- any male relative with a history of breast cancer
- 2 first-degree female relatives with breast cancer AND one of them being diagnosed at age ≤50 years
- ≥2 first- or second-degree female relatives with ovarian cancer
- ≥3 first- or second-degree female relatives with breast cancer OR a combination of breast cancer and ovarian cancer
Personal risk factors
- history of radiation therapy to the chest for treatment between age 10 and 30 years, e.g. Hodgkin’s disease
- history of breast cancer, including ductal carcinoma in situ (DCIS); lobular carcinoma
- history of atypical ductal hyperplasia or atypical lobular hyperplasia

Recommendation on screening

Should seek advice from doctors; and

have mammography screening every year;
begin screening 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.
For confirmed carriers of BRCA1/2 deleterious mutations or women who had radiation therapy to the chest for treatment between age 10 and 30 years (e.g. for Hodgkin’s disease), consider additional annual screening by magnetic resonance imaging.

Recommendation on genetic testing

Women who have any first-degree female relative with confirmed BRCA1/2 deleterious mutations should be offered genetic testing to confirm or refute their carrier status.
For women at high risk due to other types of family history who wish to clarify their genetic risk or that of their family, referral to a specialist cancer clinic for advice, counselling and management should be discussed and considered.
Genetic testing should be performed by specialised cancer centres with expertise in genetic counselling, which should be provided before and after genetic testing. Healthcare professionals should discuss with their clients in detail about the uncertainties and implications of the test results. Confirmed carriers of BRCA1/2 deleterious mutations who wish to consider prophylactic surgery / chemoprevention should also be referred to a specialist cancer clinic for advice and counselling

(B) For women at moderate risk keyboard_arrow_down

Women with family history of only one first-degree female relative with breast cancer diagnosed at ≤50 years of age; OR two first-degree female relatives diagnosed with breast cancer after the age of 50 years are recommended to have mammography every two years and should discuss with their doctors the potential benefits and harms of breast cancer screening before starting screening.
MRI is not recommended for breast cancer screening in women at moderate risk.

(C) For other women at general population keyboard_arrow_down

Women aged 44-69 with certain combinations of personalised risk factors (listed below) putting them at increased risk of breast cancer are recommended to consider mammography screening every two years and discuss with their doctors the potential benefits and harms before undergoing mammography screening.
- presence of history of breast cancer among first-degree relative
- a prior diagnosis of benign breast disease
- nulliparity and late age of first live birth
- early age of menarche
- high body mass index
- physical inactivity
A risk assessment tool for local women (e.g. one developed by The University of Hong Kong www.cancer.gov.hk/bctool) is recommended for estimating the risk of developing breast cancer with regard to the personalised risk factors described above.
MRI is not recommended for breast cancer screening in women at general population.