How Do Doctors Assess Risk For Breast Cancer
Theres currently no standardized approach to assessing an individuals breast cancer risk. However, there are several tools that help doctors identify those at a high risk of breast cancer.
Breast cancer risk assessment tools are heavily based on your personal and family history. However, they do take other factors into account as well. A few examples of commonly used tools include the:
- Breast Cancer Risk Assessment Tool , also called the Gail model
- International Breast Cancer Intervention Study risk calculator, also called the Tyrer-Cuzick model
- Claus model, based off the Cancer and Steroid Hormone Study
Risk assessment tools provide a variety of measurements. These can include 5-year risk, 10-year risk, and lifetime risk.
Whats considered high risk can vary by location. In the United States, people with an estimated 5-year risk of 1.67 percent or higher are typically considered high risk.
Why Is Breast Screening Important
Routine breast cancer screening is important for all women, but even more so for those at higher than average risk. If youre at higher risk of breast cancer, you may need to be screened earlier and more often than other women. Youre considered at higher risk if you have one factor that greatly increases risk or several factors that together,
The Brca Genes And Beyond: Inherited Risk For Breast Cancer
Women with inherited mutations in the BRCA1 or BRCA2 genes have a higher risk of breast and ovarian cancer than the general population.
About 5 to 10 percent of breast cancer occurs in people with a BRCA gene mutation. About 72 percent of women with a BRCA1 mutation and 69 percent of women with a BRCA2 mutation develop breast cancer before they are 80 years old. Without a BRCA mutation, about 12 percent of women develop breast cancer in their lifetime.
A blood test can analyze your DNA to determine whether you have mutations in either BRCA gene. However, only women with a personal or family history of breast or ovarian cancer, or those of Ashkenazi Jewish ancestry, usually undergo testing.
If you have an average risk of breast or ovarian cancer, it is not typical to get tested for BRCA mutations, and your insurance company is unlikely to cover the cost. However, some private companies offer BRCA gene testing to anyone willing to pay out of pocket.
If you decide to get tested for a BRCA gene mutation, you should seek genetic counseling as well. A counselor can help you understand your test results and your options after you receive them.
Over the years, researchers have identified other inherited genetic mutations that can raise risk, including ATM, PALB2, and TP53, among others.
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What Are The Cancer Risk Reduction Options For Women Who Are At Increased Risk Of Breast Cancer But Not At The Highest Risk
Risk-reducing surgery is not considered an appropriate cancer prevention option for women who are not at the highest risk of breast cancer . However, some women who are not at very high risk of breast cancer but are, nonetheless, considered as being at increased risk of the disease may choose to use drugs to reduce their risk.
Health care providers use several types of tools, called risk assessment models, to estimate the risk of breast cancer for women who do not have a deleterious mutation in BRCA1, BRCA2, or another gene associated with breast cancer risk. One widely used tool is the Breast Cancer Risk Assessment Tool , a computer model that takes a number of factors into account in estimating the risks of breast cancer over the next 5 years and up to age 90 years . Women who have an estimated 5-year risk of 1.67 percent or higher are classified as “high-risk,” which means that they have a higher than average risk of developing breast cancer. This high-risk cutoff is widely used in research studies and in clinical counseling.
What Is The Average American Womans Risk Of Being Diagnosed With Breast Cancer At Different Ages
Many women are more interested in the risk of being diagnosed with breast cancer at specific ages or over specific time periods than in the risk of being diagnosed at some point during their lifetime. Estimates by decade of life are also less affected by changes in incidence and mortality rates than longer-term estimates. The SEER report estimates the risk of developing breast cancer in 10-year age intervals . According to the current report, the risk that a woman will be diagnosed with breast cancer during the next 10 years, starting at the following ages, is as follows:
- Age 30 . . . . . . 0.49%
- Age 40 . . . . . . 1.55%
- Age 50 . . . . . . 2.40%
- Age 60 . . . . . . 3.54%
- Age 70 . . . . . . 4.09%
These risks are averages for the whole population. An individual womans breast cancer risk may be higher or lower depending on known factors, as well as on factors that are not yet fully understood. To calculate an individual womans estimated breast cancer risk, health professionals can use the Breast Cancer Risk Assessment Tool, which takes into account several known breast cancer risk factors.
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What Are The Potential Harms Of Risk
As with any other major surgery, bilateral prophylactic mastectomy and bilateral prophylactic salpingo-oophorectomy have potential complications or harms, such as bleeding or infection . Also, both surgeries are irreversible.
Bilateral prophylactic mastectomy can also affect a womanâs psychological well-being due to a change in body image and the loss of normal breast functions. Although most women who choose to have this surgery are satisfied with their decision, they can still experience anxiety and concerns about body image . The most common psychological side effects include difficulties with body appearance, with feelings of femininity, and with sexual relationships . Women who undergo total mastectomies lose nipple sensation, which may hinder sexual arousal.
Bilateral prophylactic salpingo-oophorectomy causes a sudden drop in estrogen production, which will induce early menopause in a premenopausal woman . Surgical menopause can cause an abrupt onset of menopausal symptoms, including hot flashes, insomnia, anxiety, and depression, and some of these symptoms can be severe. The long-term effects of surgical menopause include decreased sex drive, vaginal dryness, and decreased bone density.
Women who have severe menopausal symptoms after undergoing bilateral prophylactic salpingo-oophorectomy may consider using short-term menopausal hormone therapy after surgery to alleviate these symptoms.
What Is A High Risk Breast Clinic
If youre at high risk for breast cancer, you and your healthcare provider will work together to develop an individualized prevention, screening and risk-reduction evaluation. This may include additional screenings like a breast MRI, or referral to a breast specialist, such as Summa Healths High Risk Breast Clinic. The High Risk Breast Clinic provides on-site genetic risk evaluation, counseling and testing as well as screening and preventive options for women at increased risk of breast cancer.
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Is Breast Cancer Risk Higher Or Lower
These risks are averages for the whole population. An individual womans breast cancer risk may be higher or lower depending on known factors, as well as on factors that are not yet fully understood. To calculate an individual womans estimated breast cancer risk, health professionals can use the Breast Cancer Risk Assessment Tool,
What Are The Risk Factors For Breast Cancer
CDCs Dr. Lisa Richardson explains the link between drinking alcoholic beverages and breast cancer risk in this video.
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.
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Preventive Steps You Can Take
If youre at a high risk of breast cancer, there are preventive steps that you can take. Talk to your doctor about which ones may be appropriate for your individual situation:
- Medications: There are medications, such as tamoxifen and raloxifene, that can help to lower your risk of developing breast cancer.
- Surgery: A prophylactic mastectomy is surgery to remove one or both breasts in order to reduce the chances of breast cancer.
- Lifestyle changes: Various lifestyle changes may also help to lessen your breast cancer risk. These include:
When Should I Start Breast Screening
While some women at higher risk dont get the disease, and some women at lower risk do, it is important to start screening at age 40 to determine the risk level. Risk factors you cannot change include: Women who are Ashkenazi Jewish are also considered at higher risk of breast cancer due to the BRCA 1 and 2 gene.
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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.
Learn more about genetic counseling and testing for breast cancer or cancer in general.
Medicines To Lower Breast Cancer Risk
Two medications, tamoxifen and raloxifene, can help lower breast cancer risk by blocking estrogen in breast tissue. Raloxifene is typically only used for older women who have experienced menopause. Studies have shown raloxifene can lower your risk of future breast cancer by nearly 50 percent.
There are also drugs called aromatase inhibitors to reduce the risk of breast cancer. These drugs, sold as generic anastrozole or exemestane dont stop estrogen production, rather they lower levels by inhibiting the production of aromatase, an enzyme found in fat tissue. As a result, aromatase cant change other hormones, such as androgen, into estrogen.
While these medications are sometimes called chemoprevention, they are not considered chemotherapy and do not have traditional chemotherapy-associated side effects, Dr. Sharp says. The patients menopausal status and the side effect profile of each drug impact recommendations for which drug is best for specific patients. These medications are a single oral pill that are taken for 5 years for risk-reduction.
In those patients with dense breasts, we often have improved breast exams and breast imaging studies while they take risk-reducing medications, as the density of the breasts is often decreased. There can be significant side effects associated with these medications, so they are only prescribed to patients at substantial increased risk of breast cancer where the benefits outweigh the risks.
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How Effective Are Risk
Bilateral prophylactic mastectomy has been shown to reduce the risk of breast cancer by at least 95 percent in women who have a deleterious mutation in the BRCA1 gene or the BRCA2 gene and by up to 90 percent in women who have a strong family history of breast cancer .
Bilateral prophylactic salpingo-oophorectomy has been shown to reduce the risk of ovarian cancer by approximately 90 percent and the risk of breast cancer by approximately 50 percent in women at very high risk of developing these diseases .
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:
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What risk factors do I have? How do they affect my risk of cancer?
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What is my chance of developing cancer in the next 5 years? In my lifetime?
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What can I do to lower my risk of cancer?
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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?
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What if I find out about a new risk factor, such as a relative developing cancer? Then how much does the risk increase?
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What cancer screening tests do you recommend? How often should I have them?
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Breast Cancer: Risk Factors And Prevention
Have questions about breast cancer? Ask here.
ON THIS PAGE: You will find out more about the factors that increase the chance of developing breast cancer. Use the menu to see other pages.
A risk factor is anything that increases a persons chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. Knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.
Most breast cancers are sporadic, meaning they develop from damage to a persons genes that occurs by chance after they are born. There is no risk of the person passing this gene on to their children, as the underlying cause of sporadic breast cancer is a combination of internal, or hormonal, exposures lifestyle factors environmental factors and normal physiology, such as DNA replication.
Inherited breast cancers are less common, making up 5% to 10% of cancers. Inherited breast cancer occurs when gene changes, called mutations or alterations, are passed down within a family from parent to child. Many of those mutations are in tumor suppressor genes, such as BRCA1, BRCA2, and PALB2. These genes normally keep cells from growing out of control and turning into cancer. But when these cells have a mutation, it can cause them to grow out of control.
Example Of The Impact Of A Relative Risk
Using our example of the exercise study above, we can show how absolute risks affect the number of extra cases.
Inactive women have a 25 percent higher risk of breast cancer than active women .
Since older women are more likely to get breast cancer, a lack of exercise has a greater impact on breast cancer risk in older women than in younger women.
First, lets look at the women in the study ages 70-74 years.
The study finds 500 women per 100,000 who are inactive develop breast cancer in one year. This is the absolute risk for women with the risk factor, lack of exercise.
The study also shows 400 women per 100,000 who are active develop breast cancer in one year. This is the absolute risk for women without the risk factor.
The relative risk is 1.25 for women who are inactive compared to those who are active.
Among women ages 70-74, being inactive led to 100 more cases of breast cancer per 100,000 women in one year .
Now lets look at the women in the study ages 20-29.
The study finds 5 women per 100,000 who were inactive developed breast cancer in one year. And, 4 women per 100,000 who were active got breast cancer.
Here again, the relative risk is 1.25.
However, in women ages 20-29, being inactive led to only 1 extra case of breast cancer per 100,000 women .
So, the same relative risk of 1.25 led to many more extra cases of breast cancer in the older women than in the younger women .
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Differences By Race And Ethnicity
Some variations in breast cancer can be seen between racial and ethnic groups. For example,
- The median age of diagnosis is slightly younger for Black women compared to white women 63 years old).
- Black women have the highest death rate from breast cancer. This is thought to be partially because about 1 in 5 Black women with breast cancer have triple-negative breast cancer – more than any other racial/ethnic group.
- Black women have a higher chance of developing breast cancer before the age of 40 than white women.
- At every age, Black women are more likely to die from breast cancer than any other race or ethnic group.
- White and Asian/Pacific Islander women are more likely to be diagnosed with localized breast cancer than Black, Hispanic, and American Indian/Alaska Native women.
- Asian/Pacific Islanders have the lowest death rate from breast cancer.
- American Indian/Alaska Natives have the lowest rates of developing breast cancer.
What Is Considered High Risk For Breast Cancer
According to the CDC, you are considered high risk for breast cancer if you have:
- Strong family history of breast cancer
- Inherited changes in your BRCA1 and BRCA2 genes
These two risk factors also put you at a high risk for ovarian cancer. Speak with your doctor about what you can do to reduce your risks. Options include drugs that block or decrease estrogen in your body and preventive surgery.
Expert cancer care
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