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Approximately 50% of women who have a screening mammogram will be receiving letters including a statement suggesting consideration of other screening options. It is impossible for me to do a risk assessment on all of them. What do you suggest?

If a woman requests supplemental breast screening, it may be possible to rapidly triage the need for a risk assessment. The strongest risk factors for breast cancer, other than age and sex, are personal or family history (especially a first degree relative with premenopausal breast or ovarian cancer), and personal history of atypia on prior biopsy (ADH, ALH, LCIS). While neither of these risks, nor dense breasts, individually place a woman in the very high-risk category, they may identify those who would likely benefit from a full risk assessment, using mathematical models such as Claus, BRCAPRO, Tyrer-Cuzick (IBIS Breast Cancer Risk Evaluation Tool), BOADICEA and others. This is best conducted by someone who is fully informed on risk assessment procedures and who also can counsel the patient on the results. Clinicians who feel comfortable in this capacity can perform a risk assessment, or refer on to a cancer risk assessment program.

For patients who have had mantle radiation therapy at age