If you have a family history of breast cancer or other breast cancer risk factors, you may be wondering what your options are for breast cancer screening — and if there are ways you can lower your chances of getting breast cancer in the future.
Breast cancer risk varies from person to person. Each woman* has her own individual estimated level of risk of developing breast cancer. Only a small percentage of breast cancers — 10% or less — are associated with genetic mutations such as the BRCA 1 and 2 variants. However, someone who carries a genetic variant like this can have a much higher risk of developing breast cancer than the average person. Many other factors can contribute to increased breast cancer risk, including but not limited to:
- Inheritance. This includes genetic mutations and family history of breast cancer.
- Ethnicity. The highest numbers of breast cancers are seen in non-Hispanic white women and Black women. Black women are more likely to be diagnosed with breast cancer at a younger age than white women, and more likely to die from breast cancer.
- Breast health. Personal history of breast cancer or pre-cancer, having dense breasts on your mammogram, and a history of breast biopsies all increase breast cancer risk, though risk varies depending on biopsy results.
- Reproductive history. You have a higher breast cancer risk if you had an early start of your menstrual periods, later menopause, never gave birth or gave birth later in life, or used certain hormones after menopause.
- Lifestyle and general health. Tobacco and alcohol use, as well as obesity, all increase breast cancer risk.
- Other. Older age and a history of chest radiation are known to increase breast cancer risk.
Risk factors influence screening options
When making decisions about your breast cancer screening, it‘s important to talk to your healthcare team about your personal and family history and consider a breast cancer risk assessment. The National Comprehensive Cancer Network (NCCN) recommends this for all women, optimally by the age of 25, but this is especially important if you have risk factors for developing breast cancer.
If you have a strong family history of breast cancer or other cancers, or if you have Ashkenazi Jewish inheritance, your healthcare team may discuss the option for getting genetic counseling and testing to assess for genetic changes that can increase your risk. Genetic testing is usually done by a blood or saliva test.
Your healthcare team also may calculate your risk using a risk assessment model. Two of the most commonly used clinical tools are the Breast Cancer Risk Assessment Tool (BCRAT, otherwise known as the Gail Model) and the IBIS (otherwise known as the Tyrer-Cuzick model). These calculators help provide estimates for future risk, including your 5-year risk, 10-year risk, and lifetime risk. These calculations help guide clinical decisions to help you be more proactive about your breast health.
Women with a lifetime risk of 20% or higher on the Tyrer-Cuzick model are considered high-risk. This number helps guide decisions about breast cancer screening imaging. Those with a high lifetime risk should get familiar with their breasts and see their healthcare professional for evaluation if they notice any changes. Women with high risk also should have a clinical breast exam with their healthcare team every 6 to 12 months and get a screening mammogram (with 3D if available) every year.
Those at high risk also may consider “supplemental,” or additional, imaging with a breast MRI every year for breast cancer screening. Breast MRI uses magnetic energy and a contrast agent called gadolinium, which is given by IV, to get additional detailed views of the breast tissue, and help detect breast cancers earlier. Your healthcare team may recommend alternating a mammogram and breast MRI every six months for high-risk screening, although sometimes these tests are timed together every year. There are pros and cons to any imaging, and your provider also may discuss with you the potential risks of these tests to determine what is best for you.
If you cannot or choose not to undergo MRI, there are alternatives, such as whole breast ultrasound or contrast-enhanced mammogram.
How to reduce breast cancer risk
There also are ways to help reduce your breast cancer risk. Start with lifestyle changes like:
- Not smoking.
- Avoiding or limiting alcohol use. No alcohol is best, but if you do drink, try to limit yourself to 1 drink or less per day, and 3 drinks or less per week.
- Exercising regularly. Aim for 150 to 300 minutes of moderate activity per week.
- Maintaining a healthy body weight.
If you are taking hormones to help with symptoms of menopause, make sure to discuss the effects of hormones on your breast cancer risk with your healthcare team.
For women with a high 5- or 10-year risk, or certain types of high-risk findings on breast biopsy (such as atypical hyperplasia or lobular carcinoma in situ), your team also may offer the option to take risk-reducing medication. The four medications most commonly used for this today are tamoxifen, raloxifene (Evista), exemestane (Aromasin) and anastrozole (Arimidex). These medications help reduce the effects of estrogen exposure on the breast cells, particularly abnormal cells that can turn into cancer, and can reduce the risk of developing breast cancer. However, these medications also can be associated with their own side effects, so it is important to discuss the potential benefits and risks with your healthcare team to help decide if these medications are right for you.
Finally, some women who are at very high risk for developing breast cancer, such as those who carry harmful genetic variants, may be offered risk-reducing surgery to remove healthy breasts, referred to as a prophylactic mastectomy.
With all of the information and options out there regarding breast cancer risk and screening options, it is important to talk to your healthcare team about what is best for you based on your risk level, as well as your personal preferences. These choices can be challenging, but shared decision-making between you and a trusted healthcare team can help guide these decisions.
*For the purposes of this post, the term woman is used to refer to assigned females at birth.
Relevant reading
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