Women considered to be at high risk for developing breast cancer can take steps to protect their health and catch the disease early, when the chances of curing the disease are greatest. “The majority of cases of breast cancer are not genetic,” said Sunny Mitchell, MD, Medical Director of The Breast Center at Montefiore Nyack Hospital. “But there are some factors that may indicate an increased risk of breast cancer. Talk to your doctor about whether you are at increased risk yourself, and what you can do to reduce your risk.”
Factors that are known to increase the risk of breast cancer include:
- Genetic mutations. Inherited changes (mutations) to certain genes, such as BRCA1 and BRCA2. Women who have inherited these genetic changes are at higher risk of breast and ovarian cancer. If you are of Ashkenazi Jewish descent, you may have a higher risk for a BRCA gene mutation.
- Having dense breasts. Dense breasts have more connective tissue than fatty tissue, which can sometimes make it hard to see tumors on a mammogram. Women with dense breasts may need additional breast imaging to better visualize the breast tissue.
- Personal history of breast cancer. Women who have had breast cancer may be considered higher risk than women who have not.
- Family history of breast cancer. A woman’s risk for breast cancer may be is higher if she has a mother, sister, or daughter (first-degree relative) or multiple family members on either her mother’s or father’s side of the family who have had breast cancer. Having a first-degree male relative with breast cancer may also raise a woman’s risk.
- Previous treatment using radiation therapy. Women who had radiation therapy to the chest or breasts (like for treatment of Hodgkin’s lymphoma) before age 30 may have a higher risk of getting breast cancer later in life.
A woman may be considered at high risk of breast cancer either because of one specific factor, or a combination of factors working together.
Screening for High-Risk Women
Women who are at high risk of breast cancer are generally advised to start screening earlier, and be tested more often, than women with standard risk. Their doctor may recommend a combination of screening methods. These can include a mammogram, ultrasound, and breast MRI. “We recommend women at high risk of breast cancer have a clinical breast exam twice a year, and have regular screening,” Dr. Mitchell said. “A 3-D mammogram is the gold standard for breast cancer screening. Ultrasound can be a good supplement, especially for women with dense breasts.”
While a breast MRI is not recommended as a routine screening tool for all women, it may be recommended for screening women who are at high risk for breast cancer, usually due to a strong family history and/or a mutation in genes such as BRCA1 or BRCA2.
Some women at very high risk for breast cancer choose to have a mastectomy (removal of the breast tissue under the skin). Some women with a BRCA genetic mutation may also decide to have surgery that removes the ovaries and fallopian tubes, called a salpingo-oophorectomy.
Another option for women with very high breast cancer risk is to take medication that blocks or decreases estrogen in your body such as tamoxifen, raloxifene, or aromatase inhibitors (such as anastrozole and exemestane). These drugs are associated with a decreased risk of breast cancer.
Dr. Mitchell advises all women—including those with a high risk of breast cancer—to take steps to reduce their breast cancer risk, such as eating a well-balanced nutritious diet, and getting regular exercise. “I tell my patients to decrease or eliminate fried food, increase fruits and vegetables, include healthy fats (such as those found in fish, avocados and nuts), in their diet, and avoid excess alcohol,” she said.
She recommends women who may be at increased risk for breast cancer see a genetic counselor for a risk assessment. “Once you have an understanding of your personal risk of breast cancer, you can work with your doctor to choose a risk reduction strategy,” she said.