One in every eight women will be diagnosed with breast cancer at some point in their life. Early detection is the key to improving treatment outcomes, and knowing your risk level is important when considering screening plans. Read on for more information about understanding your risk.
What does “high risk” for breast cancer really mean?
The average woman’s risk of breast cancer is about 12 percent. However, we typically define “high risk” to mean a lifetime risk of developing breast cancer that is greater than 20 percent. This might be due to several different factors, including family history or a prior breast biopsy that did not show cancer but showed something atypical that might be worrisome. The distinction of “high risk” is important because it may mean we would recommend increased screening, lifestyle changes or even medications or surgery in an effort to catch cancer earlier or prevent it altogether.
Are there specific factors that lead to someone being considered high risk?
There are many factors that go into thinking about an individual’s breast cancer risk. A major contributor is family history, especially history of first-degree relatives with breast cancer or relatives that developed cancer at a young age. Other factors include prior breast biopsies, breast density on mammogram, gynecologic and pregnancy history and many lifestyle factors, including smoking history, alcohol use, physical activity and body weight.
Breast specialists and other physicians are able to go through an individual’s risk factors and make an estimate of breast cancer risk using their clinical judgment and the help of risk calculators, such as the Gail model.
How can I prevent or reduce my risk of developing breast cancer?
While it is not possible to change some contributors, such as family history, it is certainly possible to take charge of some of the important factors that affect breast cancer development.
Even one alcoholic drink per day can increase the risk of breast cancer, so keeping consumption under a few drinks per week is recommended.
Evidence investigating the effect of diet on breast cancer risk has been mixed. However, it is well established that a healthy body weight — avoiding being overweight or obese — substantially lowers risk of post-menopausal breast cancer.
Physical activity is very important for breast cancer risk, as a sedentary lifestyle increases risk compared to an active lifestyle. The recommended 150 minutes per week of moderate-level activity has been proven to lower risk. If 150 minutes seems like too much, start small — every bit helps!
If a woman meets criteria for “high risk,” we may also think about anti-estrogen medications to lower risk.
Who should be getting screened and how often? Are self-exams still recommended?
Screening should often be individualized based on personal risk and family history. In addition, different groups have different recommendations. Currently, I recommend annual mammograms beginning at age 40 for the general population of average risk. However, you should talk to your doctor, as it may be appropriate to begin earlier or later, or even space out the interval between mammograms. Self-exams are not currently recommended by many guidelines, as they have no proven benefit, but I recommend that all of my patients be familiar with their breasts in order to be aware of any changes.
Dr. Tarah Ballinger is a breast oncologist at IU Health Simon Cancer Center.
