When it comes to breast cancer, know your risks
How often should you have a screening? What should your prevention strategy be? It all depends on your personal risk factors.
About one in eight U.S. women will develop invasive breast cancer, but due to great medical advances, around 80 percent will survive it. Still, breast cancer remains the second-deadliest cancer in women (after lung cancer). It is important to know your personal risk factors so you can reduce your risk through lifestyle changes and receive a breast-cancer screening that is tailored to your individual situation. As I explain to my patients, lifestyle factors play a moderate role in the development of breast cancer. Weight gain after menopause, working night shifts, alcohol use and several hormone-replacement therapies are known to increase the risk. However, having a baby before age 30, breast-feeding, regular exercise and a Mediterranean-like diet — rich in fruits, vegetables, fish and olive oil — all seem to aid in reducing the risk of developing breast cancer.
When deciding on your breast-cancer prevention and screening strategy, consider the following risk factors:
• Personal and family history of breast cancer. Your risk is particularly high if breast cancer was diagnosed in a close relative (your parents, siblings or children) before the age of 45, especially if breast cancer has affected more than one relative. If you have a family history of breast cancer or other cancers (especially ovarian cancer), you should discuss with your doctor testing for hereditary cancer syndromes, such as BRCA gene mutations, as this may affect your surveillance strategy significantly.
• Menstruation. You are at a higher risk of developing breast cancer if you began menstruation at a young age or if you were older when it ended.
• Dense breasts. You have a higher risk for breast cancer if you have been told after a mammogram that you have dense breasts.
• History of breast health problems. If benign proliferative breast conditions were found on prior breast biopsies, especially histologic atypia, your risk of developing breast cancer increases.
• High bone density. Higher circulating estrogen levels increase bone density — and your breast-cancer risk. Aside from hormone replacement therapy, treatment for low bone density doesn’t increase the risk. I often recommend taking vitamin D supplements to patients with this condition, as it may actually be beneficial for both.
Despite the value of knowing your risks, many breast-cancer cases develop without obvious risk factors. This is why age-appropriate breast-cancer screenings are essential for all women. Women ages 50-74 derive the greatest benefit of regular screenings and should get a mammogram at least once every two years. While screening women ages 40-49 and healthy women older than 74 is controversial, most expert groups recommend individualizing screening based on personal risk factors.
The optimal frequency of screenings is another gray area. Most government-sponsored agencies such as the U.S. Preventative Services Task Force recommend screening mammograms at two-year intervals, while most medical societies such as the American College of Obstetricians and Gynecologists recommend an annual screening schedule. Talk to your doctor about what screening frequency is right for you.
Different risk-assessment tools have been developed to tailor screening and treatment. Depending on risk factors, screening may start as early as age 25, and a screening strategy may also entail a breast MRI and clinical breast exam by a health-care professional.
Currently, expert groups do not recommend routine breast self-exams. However, I strongly recommend getting an evaluation for any changes that you notice in your breasts, even if you have recently had a negative screening test.
When breast cancer is found in the early stages and treatment is initiated promptly, the chance for a positive outcome is improved. Over time, treatments have become less invasive and are tailored more accurately to the individual risk. This allows most women today to avoid mastectomy and chemotherapy. Because early detection is so critical, I encourage all women to address their breast-cancer risk with a sense of importance and without fear.