What Is Considered High Risk For Breast Cancer

How Is Risk Calculated

As part of your of your comprehensive breast exam, we use the Tyrer-Cuzick calculator to determine an estimated lifetime risk of breast cancer. This gives us your risk level based on family history and other information. High risk refers to a woman having a20% or greater chance of getting breast cancer in her lifetime. Intermediate risk refers to a woman having a 15-19% chance of getting breast cancer in her lifetime. The average risk for a woman in the US is 12.5%.

How Do I Know If I Am At High Risk For Breast Cancer

Some women have a higher than average risk of developing breast cancer. You may be at a higher risk if you have:

• strong family history of breast cancer
• certain gene mutations, such as the BRCA1 or BRCA2 mutation
• a personal history of lobular carcinoma in situ , ductal carcinoma in situ , invasive breast cancer or atypical hyperplasia
• dense breast tissue
• received radiation therapy to the breast or chest

Talk to your doctor about your risk. If you are at higher than average risk, you may need a personal plan for testing. This may include:

• mammography at a younger age
• more frequent mammography

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With The Cdc Warning That People With Weakened Immune Systems Are More Likely To Suffer Severe Illness From Coronavirus Many Are Wondering: Who Falls In This Category An Oncology Nurse Practitioner And Md Have The Answers

This past week, the co-operative grocery stores in my area announced their first hour of operation every day will be reserved for the elderly, pregnant women and at-risk populations as defined by the CDC.

This decision has many in my community wondering who counts as high risk. According to the Centers for Disease Control , those with chronic conditions such as heart disease, diabetes or lung disease are at higher risk for severe illness if they contract coronavirus. But the CDC also notes that people with a weakened immune system are among those most at risk.

So what exactly does it mean to be immunosuppressed and who falls in that category?

Who Has a Weakened Immune System

People who are immunosuppressed have immune systems that are highly susceptible to infectious diseases, including COVID-19, the respiratory illness caused by coronavirus. Not only are these people more likely to contract illnesses, sometimes repeatedly, but they are also more likely to have unusually severe symptoms.

A person can become immunocompromised in four major ways: through a congenital disorder through acquired conditions such as diabetes and HIV through autoimmune diseases and through certain medications and treatments.

I recently spoke with Lisa Kennedy Sheldon, Ph.D., chief clinical officer at the Oncology Nursing Society, and an oncology nurse practitioner, about the link between cancer treatments and immunosuppression.

Rushed to the ER: Life with Immunocompromise

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What Are The Most Common Risk Factors For Breast Cancer

The following risk factors have the strongest evidence behind them and are recognized as clearly affecting breast cancer risk, for better or worse.

To see more risk factors, including possible risk factors that are currently under study, visit Susan G. Komens website. There are also lots of things that are rumored to increase breast cancer risk but have been shown by research not to. Susan G. Komen has a list of those factors too.

Example Of Treatment Reducing Risk Of Recurrence

Suppose your risk of breast cancer is 12%, and then you decide to take Drug A, which can lower the risk of breast cancer by 25%.

That means your risk of breast cancer with Drug A could be 25% lower than without Drug A. That’s the Relative Risk decrease with Drug A.

But how big a difference does a 25% decrease really mean for you? Lowering your 12% risk by 25% drops your risk by 3%.

That 3% is the Absolute Risk decrease for YOU, leaving you with a risk of 9%, if you take Drug A.

Learn about risk factors for breast cancer recurrence — and ways to keep your body as healthy as it can be — in the Lower Your Risk section.

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Insurance Coverage Of Breast Mri Screening

Insurance coverage for breast MRI screening varies. You may want to check with your insurance company before getting a breast MRI for screening to see if its covered.

Why Is Screening So Important

While some tumors in the breast are aggressive and grow quickly, most grow slowly. In some cases a tumor may have been growing for as long as 10 years before it creates a lump large enough to feel. That means that even if you know whats normal for your breasts and notice when something changes, you may not feel anything until the cancers been growing for a while.

Screening tests can find breast cancer early, when the chances of survival are highest. They can find breast cancer in a person who doesnt have any early signs or symptoms. For people at a higher risk, more frequent screening can mean that if they do develop cancer, they can find it and treat it sooner.

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Assessing The Risk Of Carrying A Germline Mutation

In addition to increasing the risks of breast and ovarian cancers, germline mutations in BRCA1 and BRCA2 are associated with an increased risk of prostate cancer and BRCA2 mutations are associated with increased risks of pancreatic and gastric cancers and melanoma . BRCA mutations tend to cluster within certain ethnic groups, such as Ashkenazi Jews , and in some populations, such as those in the Netherlands , Iceland , and Sweden . Germline mutations that are associated with familial breast cancer have been identified in other genes, including TP53 , PTEN , ATM , CHEK2 , NBS1 , RAD50 , BRIP , and PALB2 , and others are suspected .

There is evidence that strategies to reduce the risk of cancer in populations that carry such mutations are effective . Therefore, identifying individuals who should undergo genetic testing for mutations is very important. Although formal mutational analysis on all patients is possible, it would be a laborious and expensive process: Full sequencing of BRCA1 and BRCA2 costs approximately US $3000 in North America but is cheaper in Europe because of the absence of substantial patent rights. Therefore, most family history clinics have been offering such testing to patients who have high-risk features, such as early-onset breast cancers or a family history consistent with germline mutations.

American Cancer Society Screening Recommendations For Women At High Risk

Women who are at high risk for breast cancer based on certain factors should get a breast MRI and a mammogram every year, typically starting at age 30. This includes women who:

• Have a lifetime risk of breast cancer of about 20% to 25% or greater, according to risk assessment tools that are based mainly on family history
• Have a first-degree relative with a BRCA1 or BRCA2 gene mutation, and have not had genetic testing themselves
• Had radiation therapy to the chest when they were between the ages of 10 and 30 years
• Have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromes

The American Cancer Society recommends against MRI screening for women whose lifetime risk of breast cancer is less than 15%.

Theres not enough evidence to make a recommendation for or against yearly MRI screening for women who have a higher lifetime risk based on certain factors, such as:

• Having a personal history of breast cancer, ductal carcinoma in situ , lobular carcinoma in situ , atypical ductal hyperplasia , or atypical lobular hyperplasia
• Having extremely or heterogeneously dense breasts as seen on a mammogram

If MRI is used, it should be in addition to, not instead of, a screening mammogram. This is because although an MRI is more likely to detect cancer than a mammogram, it may still miss some cancers that a mammogram would detect.

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Inheriting Certain Gene Changes

About 5% to 10% of breast cancer cases are thought to be hereditary, meaning that they result directly from gene changes passed on from a parent.

BRCA1 and BRCA2: The most common cause of hereditary breast cancer is an inherited mutation in the BRCA1 or BRCA2 gene. In normal cells, these genes help make proteins that repair damaged DNA. Mutated versions of these genes can lead to abnormal cell growth, which can lead to cancer.

• If you have inherited a mutated copy of either gene from a parent, you have a higher risk of breast cancer.
• On average, a woman with a BRCA1 or BRCA2 gene mutation has up to a 7 in 10 chance of getting breast cancer by age 80. This risk is also affected by how many other family members have had breast cancer.
• Women with one of these mutations are more likely to be diagnosed with breast cancer at a younger age, as well as to have cancer in both breasts.
• Women with one of these gene changes also have a higher risk of developing ovarian cancer and some other cancers.
• In the United States, BRCA mutations are more common in Jewish people of Ashkenazi origin than in other racial and ethnic groups, but anyone can have them.

Other genes: Other gene mutations can also lead to inherited breast cancers. These gene mutations are much less common, and most of them do not increase the risk of breast cancer as much as the BRCA genes.

Inherited mutations in several other genes have also been linked to breast cancer, but these account for only a small number of cases.

Questions To Ask Your Health Care Team

Statistical language can be hard to understand. So ask your health care team to explain what this information means in your situation. Consider bringing up these questions about cancer risk:

• What risk factors do I have? How do they affect my risk of cancer?

• What is my chance of developing cancer in the next 5 years? In my lifetime?

• What can I do to lower my risk of cancer?

• What if I change my behavior to eliminate a risk factor ? Then what are my chances of getting cancer in the next 5 years? In my lifetime?

• What if I find out about a new risk factor, such as a relative developing cancer? Then how much does the risk increase?

• What cancer screening tests do you recommend? How often should I have them?

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Why Is Routine Screening Not Recommended For Women 40

The chance of getting breast cancer is lower and the chance of having a false positive mammogram is higher in the 4049 age group, which can lead to further investigation, including other unnecessary procedures such as breast removal. We recommend not screening in women aged 4049, however women in this age group who are interested in screening and less concerned about its undesirable consequences should discuss their options with a physician.

Having Dense Breast Tissue

Breasts are made up of fatty tissue, fibrous tissue, and glandular tissue. Breasts appear denser on a mammogram when they have more glandular and fibrous tissue and less fatty tissue. Women with dense breasts on mammogram have a higher risk of breast cancer than women with average breast density. Unfortunately, dense breast tissue can also make it harder to see cancers on mammograms.

A number of factors can affect breast density, such as age, menopausal status, the use of certain drugs , pregnancy, and genetics.

To learn more, see our information on breast density and mammograms.

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Can A Woman Have Risk

Yes. Some women who have been diagnosed with cancer in one breast, particularly those who are known to be at very high risk, may consider having the other breast removed as well, even if there is no sign of cancer in that breast. Prophylactic surgery to remove a contralateral breast during breast cancer surgery reduces the risk of breast cancer in that breast , although it is not yet known whether this risk reduction translates into longer survival for the patient .

However, doctors often discourage contralateral prophylactic mastectomy for women with cancer in one breast who do not meet the criteria of being at very high risk of developing a contralateral breast cancer. For such women, the risk of developing another breast cancer, either in the same or the contralateral breast, is very small , especially if they receive adjuvant chemotherapy or hormone therapy as part of their cancer treatment .

Given that most women with breast cancer have a low risk of developing the disease in their contralateral breast, women who are not known to be at very high risk but who remain concerned about cancer development in their other breast may want to consider options other than surgery to further reduce their risk of a contralateral breast cancer.

What Happens If You Find Out Youre At Higher Risk

If you and your doctor determine that youre at a higher risk of breast cancer, you can decide together on next steps. Routine breast cancer screening is important for all women, but even more so for those at higher risk, so your doctor may suggest you get screened earlier and more often than other women.

You can also talk to your doctor about options for reducing your risk. Depending on your unique situation, your doctor may recommend either of the following:

• Risk-lowering drugs. Tamoxifen and raloxifene are the only drugs FDA-approved for breast cancer risk reduction in women at higher risk. Both are taken in pill form.
• Preventive surgery. For people with certain gene mutations, having surgery to remove their breasts may dramatically reduce their risk of breast cancer. Surgical removal of the ovaries can also reduce the risk of ovarian and possibly breast cancer for certain people.

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Documented Risk Factors For Breast Cancer

Documented risk factors for breast cancer are shown in , arranged roughly in order of relative risk. Relative risk denotes the risk for an individual who is positive for a factor versus the risk for an individual who is negative for a factor. A relative risk of 1 indicates that there is no increased risk, whereas a relative risk of 10 indicates that there is a 10-fold increase in risk.

Table 1. RISK FACTORS FOR BREAST CANCER

* There is controversy over whether pathologic hyperplasia detected in breast biopsy samples is directly equivalent to cytologic hyperplasia detected in samples obtained through FNA or nipple aspiration.

Begg has suggested that these relative risks are subject to ascertainment bias and may overestimate the true risk associated with germline mutations in BRCA genes.

Age

One of the best-documented risk factors for breast cancer is age. As seen in , the incidence of breast cancer is extremely low before age 30 , after which it increases linearly until the age of 80, reaching a plateau of slightly less than 500 cases per 100,000. If all women less than 65 years of age are compared with women aged 65 or older, the relative risk of breast cancer associated with increased age is 5.8.

Figure 1. Breast cancer incidence as a function of age.

Lifestyle and Environmental Factors

Alcohol Consumption

Body Mass Index

Hormone Replacement Therapy

Radiation Exposure

Reproductive Factors

Prior History of Neoplastic Disease or Hyperplasia in the Breast

Hyperplasia

Your Race And Ethnicity

White and Black women have the highest risk of developing breast cancer in their lifetime. Asian/Pacific Islander and Hispanic/Latina womens breast cancer rates fall in between two major groupings while American Indian and Alaska Native women are on the lowest end of risk.

While white women are more likely to develop breast cancer than Black women overall, they tend to be diagnosed at an older age . Black women have the highest breast cancer rates among women under age 40. Black women make up a higher percentage of triple-negative breast cancer cases.

What to do: If your race or ethnicity places you at higher risk, make sure you follow all screening recommendations to improve your chances of catching cancer early.

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What Is High Risk

“There’s not one definition of high risk,” acknowledges Judy Garber, MD, chair of the Breast Cancer Research Foundation’s scientific advisory board and director of the Center for Cancer Genetics and Prevention at Dana-Farber Cancer Institute in Boston.

“I’m afraid the field has not come to the place where they can say ‘okay, here is the cut-off for medium. Here is the cut-off for high,'” Dr. Garber says.

What some professionals can agree on is that if your lifetime risk of breast cancer exceeds 20 percent, you are considered high risk because you are eligible for annual screening with magnetic resonance imaging .