October is National Breast Cancer Awareness Month and understanding your own breast cancer risk is a crucial step to being proactive about your health. Women are aware that screening for breast cancer with an annual mammogram is important, and most women check the annual mammogram off their to-do list and forget about their risk of breast cancer for a year. But an annual screening for breast cancer versus understanding personal risk of developing breast cancer are two vastly different things. Individualized breast cancer risk assessment to determine your risk is an important metric in your overall health. Our practice’s recommendation is that all women should have an individualized breast cancer risk assessment at around age 40.
From young adulthood, women worry about their risk of developing breast cancer; we understand that just by being female, we are at risk. Most of us know the statistic, “1 in 8,” or 12% of women will develop breast cancer over the course of their lifetime. What we also know is that many women are at much higher risk – and they don’t know it. Conversely, other women are at a substantially lower risk of developing breast cancer than the general population. For these women, focusing on other efforts pertinent to their individualized risk profile – such as diabetes and heart disease prevention – might be more appropriate than enhanced breast cancer detection efforts.
Imaging tests including mammography, ultrasound and breast MRI are tests that detect breast cancer. These tests do not prevent cancer or help an individual woman understand her risk. And while early detection is critical because survival rates have significantly improved for women with early disease, prevention of breast cancer entirely is the winning ticket for any individual woman.
Research continues to shed light on specific factors that impact an individual woman’s risk for breast cancer. Clinically validated risk models, such as Gail and IBIS Version 8 (Tyrer-Cusick), incorporate factors such as body height and weight, alcohol intake, age at puberty, age at first birth, family history, and breast density to determine an individual woman’s risk. They also compare that risk to the average risk of breast cancer for a woman the same age in the population. Although current models cannot predict with certainty who will or will not develop the disease, these models help providers identify women who may be at higher-than-average risk.
Based on the calculated 5-year, 10-year, and lifetime risk for breast cancer, your doctor can suggest a personalized plan to reduce risk and help prevent breast cancer. Recommendations may include genetic consultation, lifestyle modifications, medications to reduce risk, and enhanced screening with 3D mammography/tomosynthesis, ultrasound, or breast MRI.
Up to 75% of women who develop breast cancer have no family history or any known inherited genetic cause. Our understanding of genetics and breast cancer is rapidly evolving. Now, more than a dozen genes are known to be associated with hereditary breast cancer, and there is emerging information about the association of Single Nucleotide Polymorphism (SNP) and breast cancer. A genetic mutation should be suspected in families who have early onset breast cancer (before age 50), triple negative breast cancer, or cancer in several generations.
In the U.S., 30% of breast cancer cases are believed to be related to lifestyle factors. What if it were possible for someone to influence their own breast cancer risk from childhood? As we come to understand more about modifiable risk factors for breast cancer, we are realizing we can! Healthy behaviors starting early in life, including a diet filled with fresh fruits and vegetables, getting plenty of exercise, avoidance of obesity, not smoking, and limiting alcohol exposure can have a dramatic impact on breast cancer risk later.
Breast density compares the amount of fat to the amount of tissue on a mammogram. Dense breasts have less fatty tissue and more nonfatty or gland tissue compared to breasts that aren’t dense. Breast density can be inherited, too, so if your mother has dense breasts, it’s likely you will too. Breast density isn’t based on how breasts feel on exam but is determined on a mammogram. There are four groups: fatty, scattered fibroglandular densities, heterogenous density, and extremely dense breast tissue. Research shows that dense breasts can be six times more likely to develop cancer and can also make it harder to detect abnormalities on mammogram.
So, remember, getting a mammogram isn’t the same thing as understanding your own personal breast cancer risk. We now have useful clinical risk assessment tools to determine whether a person is at higher or lower than average risk of developing the disease. That can determine next steps to lower risk. Do you know your breast density? Finally, genetics plays a role in about 25% of breast cancers, and healthy lifestyle changes can have a significant impact on overall breast cancer risk reduction.
Dr. West provides Breast Cancer Risk Assessments at no additional charge to members of her practice. She’s also pleased to offer them to people who are not yet members for a small fee through a Women’s Health Consult. Contact us via email, the website eileenwestmd.com, or call 571-999-9378 to schedule your assessment today!