High Risk for Breast Cancer?
Do you have a high risk for breast cancer? Are you genetically predisposed or concerned that you could be?
So, let’s get started with some fundamentals. As a basic premise the two biggest risk factors for the development of breast cancer are:
(1) female biology - being a woman
(2) increasing age - getting older
And because 75% of women who get a diagnosis of breast cancer have no known additional identifiable risks based on our current medical knowledge it is recommended that the average risk woman who is asymptomatic should start yearly screening mammograms at age 40. Repeated annual examinations are emphasized to ensure detection of small or subtle findings as early as they can possibly be recognized as abnormalities.
However, there are some well documented specific factors and circumstances that increase a woman’s lifetime risk of getting breast cancer. One of the most important things a woman can do is determine her lifetime risk for breast cancer to determine whether she needs to have increased frequency of testing, start at an earlier age, or screen with additional tools such as ultrasound or MRI.
In breast imaging the term “high risk” is defined as a 20% or greater risk of getting breast cancer in a woman’s lifetime.
These are some factors that may put you at higher risk for developing breast cancer:
Family history of breast or ovarian cancer (too many, too young, too unusual)
Personal history of ovarian cancer
Personal history of breast cancer
Personal history of midline chest (mantle) irradiation (for lymphoma treatment)
High-risk pathology on a breast biopsy (such as atypical findings)
Gene positivity (BRCA or other gene mutation)
Ashkenazi Jewish heritage
Breast Density (breast density is an independent factor for breast cancer risk)
These factors impart varying degrees of risk and thus differing recommendations for screening and assessment. For example, women with BRCA positivity need to be seen in a high risk clinic with providers who include discussion of breast screening tools such as MRI, discussion of ovarian screening and possible testing of other family members.
So how do you know what your risk is and whether you are high risk? I recommend consulting with your primary provider or use a genetic assessment tool such as Gail model or Tyrer-Cuzick model. Many mammography practices incorporate a risk assessment tool into their new patient questionnaire and this can provide valuable information for you and your doctor. Additionally, consulting with a genetic counselor who can do a thorough history/evaluation and who can provide blood testing and recommendations post testing, if needed.
For more information read:
The Breast Test Book: A Woman’s Guide To Mammography And Beyond.
Chapter 2. The Screening Mammogram Guidelines Controversy: What You Absolutely Must Know.
Chapter 9. How It Works: The Screening Evaluation; Screening The Asymptomatic Population And Saving Lives.