Would appreciate recommendations for management/screening on a 40 yr female who completed chest radiation for lymphoma at age 37. She has completed all treatment for lymphoma and was dismissed from oncology screening. NCCN Guidelines for imaging/surveillance are for younger age exposure but would expect she has future risk too. Another provider had already starting breast imaging2 years ago for concerned increased risk (although quite soon post radiation therapy to perhaps pose a risk). She was found to have a fibroadenoma which allowed for some increased imaging last year. She has no family cancer history to offer an elevated risk on TCv8. Looking for some clinical experience guidance on management with those older than guidelines. Thank you-

Expert Response: I would recommend starting screening 3D mammogram now and continue annually. She will be 8 years out from her lymphoma diagnosis at age 45 and then would recommend starting breast MRI annually. Agree the TCv8 is not helpful as she does not have a family history. If she has dense breast tissue on mammogram ( D density), could consider starting supplemental imaging with breast MRI now and in conjunction with the 3 D mammogram.