Understanding Your Breast Cancer Risk

Are you at risk of breast cancer? Of course. Every woman is.

The issue is how much — and if you're like most women, you don't have a clear idea. Some new tools can help you and your doctor assess your risk more accurately. For those at high risk, there are also some new options.

Researchers haven't yet discovered all the factors involved in breast cancer, says Nadesda Mack, R.N., B.S.N., program director of Breast Health Services at Lehigh Valley Hospital and Health Network. But we do know these:

Breast Cancer Risk Factors

• Age. Breast cancer risk rises with every decade of a woman's age. The greatest number of cancers occurs in women over age 60.
• Family history. Risk rises for each close relative (especially first-degree relatives: mother, sister, daughter) who had the disease, particularly if she had it before menopause.
• "Breast cancer genes." Genetic testing can identify mutations in two genes related to breast cancer risk, an extremely rare condition that may raise lifetime risk to as high as 80 percent.
• Previous biopsies for certain types of breast disease (not all) associated with increased cancer risk.
• Estrogen-related factors. While estrogen does many good things for you, the more monthly cycles you have in a lifetime — due to early menstruation (before age 12), late menopause or no children — the higher your breast cancer risk. First pregnancy after age 30 also raises the risk.

If you want to calculate your risk, you may have heard of the National Cancer Institute's "risk disk" questionnaire. It's a useful tool, says Mack, provided you correctly interpret the results. Some women's situations don't fit the criteria used in this particular risk model. She points to the case of a woman whose mother hadn't had breast cancer, but each of her mother's six sisters had. "The questionnaire did not accurately capture this woman's risk because it looked only at first-degree relatives," she says.

For most women, the problem isn't underestimating but overestimating breast cancer risk. One reason is the well-publicized statistic: "One in eight women will get breast cancer." This figure refers to the cumulative lifetime risk for women who live past age 85. For most of your life, your risk is far lower (see accompanying chart). "But that doesn't mean you shouldn't take breast cancer seriously," Mack says. "There are important preventive actions every woman should take."

Action Steps for Everyone

• Have a mammogram every year beginning at age 40 (earlier for some women at increased risk; ask your health provider).
• Do monthly breast self-exams.
• Have a professional breast exam every year.
• Watch your diet. Breast cancer has been linked with obesity and fat consumption. Avoid saturated fats and "hydrogenated" products. Limit alcohol and eat plenty of fresh fruits and vegetables. These habits protect against heart disease as well as cancer.
• Exercise regularly to control weight and reduce stress, and for general good health.

For Those at High Risk
"Seek counseling from a health provider knowledgeable about breast cancer risk," Mack says. "He or she can help you with genetic testing if appropriate, and can also help you calculate the risks and benefits of other options." These include:

• Tamoxifen. Research to date has shown a 44 percent decrease in incidence of breast cancer in high-risk women taking this breast cancer treatment drug. But the data are based on just seven years; longer-term studies are needed.
• Preventive mastectomy. Some women at very high risk choose to have their breasts surgically removed (usually with immediate reconstruction). "Although recent reports show that this approach dramatically reduces the expected breast cancer incidence in women who have the surgery, there remains up to a 10 percent risk of developing breast cancer despite preventive surgery," Mack says. "Obviously, such a decision should be made with extreme care."

What About Hormone Replacement Therapy (HRT)?
"The link between HRT and breast cancer is complex," Mack says. "Long-term HRT use may be associated with increased breast cancer risk. However, using HRT may decrease the risk of osteoporosis and of dying from heart disease. Carefully weigh any decision about HRT with your doctor."

Want to know more? For information on breast lumps and how to do a breast self-exam correctly, or for referral for testing or counseling, call 877-722-HOPE (4673) or 610-402-CARE.

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