Some women are more prone to getting breast cancer than others. Knowing your risk may prove empowering, especially at a time when prevention efforts are growing in both importance and availability. With today’s focus on preventing cancer when possible, some medical leaders are designing programs specifically to identify high-risk women and help them avoid becoming the one in eight women who will be diagnosed with breast cancer in her lifetime.
The key to such programs is measuring risk—the kind that extends beyond lifestyle choices and boils down to biology and genetics. All women are at risk for breast cancer, but not all women have the same degree of risk. The main risk factors for breast cancer are age and certain inherited genes. Having a risk factor, or even many of them, does not mean you will get the disease. After all, if scientists estimate that one in eight women will develop breast cancer, that means the average woman has an 88 percent of avoiding it.
Information on risk may prove helpful, if used with guidance from a cancer care professional. Women at above-average risk for breast cancer, for example, may opt for earlier or additional screening, though recommendations vary. The American Cancer Society (ACS) recommends that women at average risk for breast cancer begin receiving annual mammograms by age 45. However, the American College of Obstetricians and Gynecologists recommends starting at 40, while the U.S. Preventive Services Task Force Services says low-risk/healthy women can wait until they turn 50 to begin receiving mammograms, then get them every other year thereafter. But for women who may be more prone to developing breast cancer—those with a lifetime risk of 20 percent or higher or a known BRCA1 or BRCA2 mutation—the ACS recommends a more intensive screening regimen, which includes annual MRI scans and mammograms.
“A breast MRI is one of the most sensitive tests for breast cancer at this time,” says Dr. Anita Johnson, the Breast Surgeon who runs the High Risk Breast Cancer Prevention Program at our hospital near Atlanta.
Understanding your risk may also affect your medical decisions—from deciding whether to get a mammogram if you have no symptoms of cancer, to determining how aggressively to pursue prevention strategies. Dr. Johnson says patients may become overwhelmed by the sometimes-voluminous amount of information that may come with measuring risk, and recommends working closely with an oncologist in determining what to do with the information. “It is only confusing if you’re not well informed,” she says. “Most women do not understand their risk of getting breast cancer because it isn’t talked about enough.”
In 2013, Tori Thompson was only 25 when she learned she had an increased risk for breast cancer. Tori’s mother, Beverly Thompson, was diagnosed with triple-negative breast cancer and tested positive for the BRCA2 gene mutation. Tori wanted to know whether she also carried the mutation, and with it, an increased risk for breast and ovarian cancer. “I got tested immediately, because I would rather know something than not,” she says. “I didn't make this decision lightly. I talked about it and prayed about it with my family.”
Testing revealed that Tori was also BRCA2-positive. After consulting with numerous doctors and genetic experts, she chose to undergo a preventative double mastectomy and reconstructive surgery. Although mother and daughter were diagnosed with BRCA2, inheritable breast cancers are relatively rare—accounting for 5 percent to 10 percent of all U.S. cases, according to the National Cancer Institute.
“For me personally, it felt a lot better to do something about it when I could,” says Tori Thompson, who reports that both she and her mom are doing well today. “My mom recently had the same surgery, and I felt supported by my family and friends. I was given the gift to throw the first punch at cancer, and I'm grateful for that opportunity.”
Dr. Johnson says knowing your cancer risk is just one key aspect of prevention. Seeing the right doctor to assess your risk is another. “High-risk individuals should be screened by a physician trained in managing cancer risk,” says Dr. Johnson. According to the National Cancer Institute, preventive surgery has been shown to reduce the risk of breast cancer by at least 95 percent in women with the BRCA gene mutation and by up to 90 percent in women who have a strong family history of breast cancer. “In today’s health care environment, high-risk women should not wait until they get cancer in order to receive treatment,” says Dr. Johnson. “High-risk women should be seen by a doctor, given a clinical breast exam and screened closely.”
A risk designation may be determined in several ways. One specific factor may be identified, or a combination of factors may be working together to increase the possibility of a breast cancer diagnosis. Such risks include:
- Breast cancer gene mutations or known genetic mutations (BRCA1, BRCA2 etc.)
- A first-degree family member (parent, sibling, child) with breast cancer
- Strong family history of breast cancer
- Personal history of invasive breast cancer or ductal carcinoma in situ (DCIS)
- Lobular carcinoma in situ (LCIS) or atypical hyperplasia
When combined, factors that may also increase the risk for breast cancer include:
Family history is included on both lists because it is an importance indicator of risk. “What’s important is the age at which the family member was diagnosed,” says Dr. Johnson. “A first-degree family member diagnosed before the age of 45 could mean a higher risk than others.”
Even so, fewer than 15 percent of all women diagnosed with breast cancer have a family history of the disease, according to the ACS. Doctors may also use screening tools like questionnaires to determine if a woman is at higher risk for developing breast cancer. “We use a risk assessment tool for our patients,” says Dr. Johnson. “If it determines someone is at high risk for breast cancer mutations, we work with them to develop a personalized prevention plan that may include surveillance, chemoprevention, risk reduction surgery, nutrition and naturopathic consultation and genetic testing.”
Surveillance may include yearly mammograms or biannual checkups, a breast CT scan and/or a breast MRI. Chemoprevention includes taking medication like tamoxifen to lower the risk of cancer. Nutrition and naturopathic therapies may help manage inflammation, obesity and certain side effects of medication. Genetic testing may be an option for women who have a significant family history of breast cancer or have other factors that put them higher risk for developing the disease.
“The bottom line is that high-risk women shouldn’t wait to get cancer,” says Dr. Johnson. “If you have a four- to five-fold risk of getting breast cancer, you should act to protect yourself before the disease develops.”
No case is typical. You should not expect to see these results.
Learn more about preventive measures that may help reduce cancer risk.