Table 2: Risk ascertainment criteria and surveillance recommendations
Risk category	Risk ascertainment criteria	Surveillance recommendations
High	Family history of breast cancer in 2 or more first-degree relatives Family history of breast or ovarian cancer that suggests inherited disease (collection of first- and second-degree relatives) Bilateral or premenopausal (< 45 years) breast cancer in 1 first-degree relative Atypical hyperplasia Lobular carcinoma in situ	Surveillance is started at age 40 or 10 years before the earliest age at which cancer was detected in the family (whichever comes first) or at the time of diagnosis of atypical hyperplasia or lobular carcinoma in situ. Surveillance includes: mammography* -- annually clinical breast examination (CBE) -- every 6 months BSE -- monthly
Moderate	Family history in which a number of breast cancer cases exist but the pattern is less likely to be hereditary, and in which high-risk criteria are lacking Exposure to high-dose radiation (estimated > 100 cGy) in those under age 30 (e.g., for treatment of Hodgkin disease)†	Surveillance is started at age 40 or 10 years before the earliest age at which cancer was detected in the family, or 5 to 10 years after exposure to high-dose radiation. Surveillance includes: mammography* -- annually CBE -- annually BSE -- monthly
Slightly increased	Family history limited to 1 relative with postmenopausal disease Early menarche (<12 years), late menopause (> 55 years), late age at first live birth (> 30), nulligravid, use of hormone replacement therapy Benign breast disease High alcohol intake (> 4 oz. [112 mL] daily)	Surveillance is started at age 40 and includes: mammography* -- annually CBE -- annually BSE -- monthly
*Not done in women under age 30 or in those who are pregnant or lactating. †Patients exposed early in adolescence may have a higher risk of cancer.

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