High Risk Group #: Having Dense Breasts
The density of your breasts is a factor observable only under a mammogram. This is because on the outside all breasts feel alike.
It’s only when you scan them that it is revealed whether they are mostly made of fat tissue or mostly made of connective tissue .
And if your breasts have more of the latter, then it is a problem because the dense structures prevent lumps or tumors from showing up on the scan.
How To Find Out If You Have Dense Breasts
In the United States, 37 states and Washington, D.C., require breast imaging centers to give women some level of information about breast density after their mammogram. In 2019, the U.S. Food and Drug Administration began to develop a single national reporting standard imaging centers can use to notify both the woman and her doctor about her breast density. However, this hasnt yet been implemented.4
Federal law requires that all women receive a letter notifying them about the results of their mammogram. In most states, this form letter now also tells you if you have dense breasts, and, in some states, your specific density category. However, the content of the letter varies widely by state and may not include specific details about your situation. Most of the letters will advise you to discuss your results with your doctor. Your breast density is also included in the final mammography report to your healthcare provider, prepared by the radiologist who read the images. If you live outside the United States, you may or may not be notified about your breast density, depending on the regulations in your country. DenseBreast-info.org is a good resource for finding out what the laws are where you live.
Having dense breasts isnt your fault, and it isnt something you can control. Breast density is thought to be inherited in part, although the amount of dense breast tissue you have can change over time. Breast density can decrease as you go through menopause.
Not Being Physically Active
Evidence is growing that regular physical activity reduces breast cancer risk, especially in women past menopause. The main question is how much activity is needed. Some studies have found that even as little as a couple of hours a week might be helpful, although more seems to be better.
Exactly how physical activity might reduce breast cancer risk isnt clear, but it may be due to its effects on body weight, inflammation, hormones, and energy balance.
The American Cancer Society recommends that adults get 150 to 300 minutes of moderate intensity or 75 to 150 minutes of vigorous intensity activity each week . Getting to or going over the upper limit of 300 minutes is ideal.
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Hormone Therapy After Menopause
Hormone therapy with estrogen has been used for many years to help relieve symptoms of menopause and help prevent osteoporosis . This treatment goes by many names, such as post-menopausal hormone therapy , hormone replacement therapy , and menopausal hormone therapy .
There are 2 main types of hormone therapy. For women who still have a uterus , doctors generally prescribe estrogen and progesterone . Progesterone is needed because estrogen alone can increase the risk of cancer of the uterus. For women whove had a hysterectomy , estrogen alone can be used. This is known as estrogen replacement therapy or just estrogen therapy .
Combined hormone therapy : Use of combined hormone therapy after menopause increases the risk of breast cancer. This increase in risk is typically seen after about 4 years of use. Combined HT also increases the likelihood that the cancer may be found at a more advanced stage.
The increased risk from combined HT appears to apply mainly to current and recent users. A womans breast cancer risk seems to go back down within 5 years of stopping treatment.
Estrogen therapy : Studies of the use of estrogen alone after menopause have had mixed results, with some finding a slightly higher risk and some finding no increase. If ET does increase the risk of breast cancer, it is not by much.
To learn more, see Menopausal Hormone Therapy and Cancer Risk.
Making Sense Of Your Risk Factors
Figuring out your breast cancer risk isnt simple, so its important to work with your doctor to do it. Doctors often use The Breast Cancer Risk Assessment Tool to estimate risk, but this model may not be the most accurate tool for black women. There are other risk assessment tools out there, so talk to your doctor about which might work best for you.
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What Are The Risk Factors For Breast Cancer
Being a woman and getting older are the main risk factors for breast cancer.
Studies have shown that your risk for breast cancer is due to a combination of factors. The main factors that influence your risk include being a woman and getting older. Most breast cancers are found in women who are 50 years old or older.
Some women will get breast cancer even without any other risk factors that they know of. Having a risk factor does not mean you will get the disease, and not all risk factors have the same effect. Most women have some risk factors, but most women do not get breast cancer. If you have breast cancer risk factors, talk with your doctor about ways you can lower your risk and about screening for breast cancer.
Your Race And Ethnicity
Overall, white women are slightly more likely to develop breast cancer than African American women, although the gap between them has been closing in recent years. In women under age 45, breast cancer is more common in African American women. African American women are also more likely to die from breast cancer at any age. Asian, Hispanic, and Native American women have a lower risk of developing and dying from breast cancer.
Risk in different groups also varies by type of breast cancer. For example, African American women are more likely to have the less common triple-negative breast cancer.
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Understanding Your Risk Of Breast Cancer
Several breast cancer risk assessment tools have been developed to help a woman estimate her chance of developing breast cancer. The best studied is the Gail model, which is available on the National Cancer Institutes website at www.cancer.gov/bcrisktool. After you enter some personal and family information, including race/ethnicity, the tool provides you with a 5-year and lifetime estimate of the risk of developing invasive breast cancer. Because it only asks for information about breast cancer in first-degree family members and does not include their ages at diagnosis, the tool works best at estimating risk in women without a strong inherited breast cancer risk. For some women, other ways of determining the risk of breast cancer may work better. For example, women with a strong family history of breast cancer risk should consider talking to a genetic counselor.
It is important to talk with your doctor about how to estimate your personal risk of breast cancer and to discuss risk-reducing or prevention options .
A Family History Of Breast Cancer
Having someone in your family with breast cancer doesnt automatically mean your own risk is increased. For most people, having a relative with breast cancer does not increase their risk.
However, a small number of women and men have an increased risk of developing breast cancer because they have a significant family history.
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Women At Higher Risk Of Breast Cancer
Factors that greatly increase breast cancer risk include :
- A BRCA1 or BRCA2 inherited gene mutation
- A personal history of invasive breast cancer or ductal carcinoma in situ
- A personal history of lobular carcinoma in situ or atypical hyperplasia
- Radiation treatment to the chest area between ages 10-30
- Li-Fraumeni, Cowden/PTEN or Bannayan-Riley-Ruvalcaba syndrome
- An ATM, BARD1, BRIP1, CDH1, CHEK2, NBN, NF1, PALB2, PTEN, RAD51C, RAD51D, STK11 or TP53 inherited gene mutation
- A greater than 20 percent lifetime risk of invasive breast cancer based mainly on family history
Figure 3.5 below outlines the National Comprehensive Cancer Network breast cancer screening guidelines for women at higher than average risk up to age 75.
The NCCN recommends women older than 75 talk with their health care providers about a breast cancer screening plan thats right for them.
Figure 3.6 below outlines the American Cancer Society breast cancer screening guidelines for women at higher than average risk .
Figure 3.5: NCCN breast cancer screening recommendations for women at higher than average risk
Every year starting at age 30 or age recommended by health care provider
Every year starting at age 30 or age recommended by health care provider
Adapted from ACS materials .
How Has The Risk Of Being Diagnosed With Breast Cancer Changed In Recent Years
For a woman born in the 1970s in the United States, the lifetime risk of being diagnosed with breast cancer, based on breast cancer statistics from that time, was just under 10% .
The last five annual SEER Cancer Statistics Review reports show the following estimates of lifetime risk of breast cancer, all very close to a lifetime risk of 1 in 8:
- 12.83%, based on statistics for 2014 through 2016
- 12.44%, based on statistics for 2013 through 2015
- 12.41%, based on statistics for 2012 through 2014
- 12.43%, based on statistics for 2011 through 2013
- 12.32%, based on statistics for 2010 through 2012
SEER statisticians expect some variability from year to year. Slight changes may be explained by a variety of factors, including minor changes in risk factor levels in the population, slight changes in breast cancer screening rates, or just random variability inherent in the data.
Howlader N, Noone AM, Krapcho M, et al. . SEER Cancer Statistics Review, 19752017, National Cancer Institute. Bethesda, MD, , based on November 2019 SEER data submission, posted to the SEER web site, April 2020.
- Reviewed:December 16, 2020
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Family History Of Breast Cancer
Family history and genetics are two risk factors for breast cancer. While researchers continue to search for the definite causes of breast cancer, some consider young women at high risk for breast cancer if they have either a strong family history of breast or ovarian cancer and/or genetic mutations associated with breast cancer.
All cancers come from genetic mutations. Usually, these happen in specific cells during a persons life. In some cases, however, people inherit mutations that can influence cancer. When these mutations help cause breast cancer, doctors call it hereditary breast cancer.
Hereditary breast cancer may be indicated by a strong family history of breast or ovarian cancer. This could mean two or more relatives with breast or ovarian cancer, a relative with both breast and ovarian cancer, a male relative with breast cancer or a relative diagnosed at a young age with breast cancer.
Understand Your Breast Cancer Risk Factors
The cause of breast cancer is currently unknown, but certain risk factors have been identified. Some are beyond your control, including growing older, family history and certain gene changes. Fortunately, there are also factors several that you can control some even through simple lifestyle changes:
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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.
Reproductive History Estrogen Is The Main Hormone Associated With Breast Cancer Estrogen Affects The Growth Of Breast Cells Experts Believe That It Plays An Important Role In The Growth Of Breast Cancer Cells As Well The Type Of Exposure And How Long Cells Are Exposed To Estrogen Affects The Chances That Breast Cancer Will Develop
The start of menstruation is called menarche. Early menarche is when menstruation starts at an early age . Starting your period early means that your cells are exposed to estrogen and other hormones for a greater amount of time. This increases the risk of breast cancer.
Menopause occurs as the ovaries stop making hormones and the level of hormones in the body drops. This causes a woman to stop menstruating. If you enter menopause at a later age , it means that your cells are exposed to estrogen and other hormones for a greater amount of time. This increases the risk for breast cancer. Likewise, menopause at a younger age decreases the length of time breast tissue is exposed to estrogen and other hormones. Early menopause is linked with a lower risk of breast cancer.
Late pregnancy or no pregnancies
Pregnancy interrupts the exposure of breast cells to circulating estrogen. It also lowers the total number of menstrual cycles a woman has in her lifetime.
Women who have their first full-term pregnancy after the age of 30 have a slightly higher risk of breast cancer than women who have at least one full-term pregnancy at an earlier age. Becoming pregnant at an early age reduces breast cancer risk.
The more children a woman has, the greater the protection against breast cancer. Not becoming pregnant at all increases the risk for breast cancer.
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What Does High Risk For Breast Cancer Really Mean
One out of every eight women will develop breast cancer in their lifetime this is considered average risk for U.S. women. High risk for breast cancer is defined as a greater than or equal to 20% lifetime risk, or in other words, a one in five chance of developing breast cancer over a lifetime. We all know someone a coworker, family member such as a mother, sister, daughter or friend that has been diagnosed with this disease.
Thats why for decades, October and the color pink have gone hand in hand to promote Breast Cancer Awareness. Regular screenings and a healthy lifestyle have been shown to reduce a womans risk for developing breast cancer. In addition to these important actions, you need to be aware of our own individual lifetime risk for breast cancer. Summa Health answers your top questions about what it means to be high risk and how you can take charge of your breast health this month and every month to reduce your risk of breast cancer or detect it at its earliest stages when it is most treatable and curable.
How do I know my risk for Breast Cancer?
The risk for breast cancer is not the same for all women, as it depends on your individual health history and family history. A high risk designation can be determined by one factor or a combination of factors.
What factors increase my risk for Breast Cancer?
High Risk Group #: Using Oral Contraceptive Pills
While oral contraceptive pills are known to reduce the risk of ovarian and uterine cancer, they also have their unique set of side effects.
One such side effect is the increased risk of developing breast cancer.
So if you are taking oral contraceptive pills at the moment, or used to take them until recently, we recommend that you speak to your gynecologist to know which pills are safe to take and which ones increase your breast cancer risk.
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Genetic Counseling & Testing
If you have a family history of breast cancer, our comprehensive cancer risk assessment program can help address any hereditary concerns, including the BRCA gene.
A board-certified genetic counselor will take a detailed family history, and look at lifestyle and environmental factors. Together, you can then determine if you should have a blood test to look for potentially harmful gene mutations.
Based on the results of testing, your counselor will work closely with you and your primary care doctor on prevention and risk-reduction strategies.
Understanding Breast Cancer Risk
Lisa Schlager does not regret getting preventive surgeries to remove her ovaries at age 40 and her breasts at 41, but there were costs.
“If I could do it again, I don’t think I’d change what I’ve done. But there’s definitely a sense of melancholy that this is what it came to that this is what I had to do,” Schlager says. She hopes for better options for her 16-year-old daughter.
For most women, the lifetime risk of breast cancer is about 12 percent if you live to be 90. But for Schlager who discovered in 1999, at age 32, that she carries the BRCA1 genetic mutation the risk was four to five times higher prior to her bilateral mastectomy.
Women at above-average risk for breast cancer may need to consider earlier or additional screening than women at average risk or even medication or surgery to lower their risk.
The tricky part is that “high risk” is not black and white, nor are screening guidelines clear cut for women at elevated cancer risk.
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