High Risk for Breast Cancer

Who? What? When?

Being high risk for breast caner means having a greater chance than an "average" person to develop the disease. There are multiple factors that are taken into account such as, genetic mutations, family history, lifestyle choices, previous medical conditions.

At age 25-30 your primary doctor should evaluate you as being high risk by asking a series of questions:

Have you personally been diagnosed with any cancers?
Do you have any relatives with breast cancer or any types of cancer?
Do you have any known genetic mutations in your family?
Have you ever had any breast biopsies or surgeries before?
When was your first period?
Do you still get your menstrual cycle? If yes- when was it last?If no- when did it stop?
Have you been pregnant? If yes- how many pregnancies, deliveries, miscarriages/abortions?
Did you breastfeed? If yes- for how long?
Have you ever taken oral contraceptives? If yes- for how long?
Have you ever used hormone replacements or hormone supplements?
Did you ever receive radiation to your chest before?
Do you exercise?
Do you drink alcohol or smoke tobacco?

There are different risk assessment tools your doctor can use. Generally they input the pertinent answers to the above questions and the tool calculates a percentage of risk. There are different statistical tools, one of the most common used is the Tyrer-Cuzick model. This model can estimate a women's 10 year risk of developing breast cancer and a lifetime risk up to age 85. Like all risk assessment tools, every model has its own limitations and may not be accurate for all populations. These are predictions based on available data, but are still estimates. With this model generally people with calculated lifetime risk of >20% are considered "high risk".

There is a misconception that breast cancer always runs in families. In fact, the majority of breast cancer happens in patients with no family history of breast cancer. Only 5-15% of all breast cancers are considered familial. These cancers happen in families due to gene mutations in the DNA that is passed down generation to generation. The most notable genes associated with inherited breast cancers is BRCA1 and BRCA2. The BRCA mutations are associated with a 45-85% lifetime risk for breast cancer. This is the gene Angelina Jolie was found to have. There are other gene mutations associated with breast cancer that you may be tested for if there is breast cancer in your family.

Okay so you were evaluated and determined to be "high risk" for breast cancer, now what?

This is when your doctor will discuss with you, or refer you to a breast specialty team to discuss with you, options for "high risk screening." These recommendations depend on your age and sometimes other factors. In general you would be recommended to consider having imaging of your breasts with either a mammogram or an MRI of the breast. If you are under the age of 30, but found to be high risk, generally you are recommended to have MRIs and possibly ultrasounds. If you are over the age of 30, and found to be high risk, generally you are recommended to have mammograms and MRIs.

In addition to screening, your doctor may discuss with you medications that can be taken or surgeries to consider in certain instances, to decrease your breast cancer lifetime risks. Your doctor will likely also counsel you on lifestyle modifications that are things you can do to try to limit your overall breast cancer risk. These things may include following a well balanced healthy nutrition lifestyle, participating in daily exercise activity, limiting estrogen exposure (e.g. birth control or hormone replacement/supplements), recommending breastfeeding if possible, limiting alcohol consumption to less than 3 drinks per week, and smoking cessation.