Breast Cancer Risk Assessment

A risk factor is anything that increases the possibility of developing a disease. The exact cause of breast cancer is not known. Having a risk factor does not mean that a woman will get breast cancer. Every woman’s body is different. Risk calculation should always be evaluated by a doctor.

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Breast Cancer Examination

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Women with low to average risk

For women at low to average risk for breast cancer, the following screening procedures may be recommended:

  • Clinical Breast Examination (CBE): Clinical breast examinations (CBEs) can be recommended every 1 – 3 years starting at age 20-25, and annually (every year) starting at age 40-45. Not all screening guidelines recommend CBEs, so talk to your doctor about this breast examination.
  • Mammogram: Most screening guidelines recommend annual (every year) mammograms starting at age 40-45.

Routine breast self-examinations (BSE) are neither recommended nor discouraged by screening guidelines. Women may choose to perform periodic BSEs based on their personal preferences. However, women should be aware of their breast health and report any changes or warning signs to their doctor immediately.

Women may have a low to average risk if they:

Older women
Are Over the Age of 50

Women over the age of 50 are at an increased risk for breast cancer.

Caucasian women
Are Caucasian

White women may be at slightly higher risk for breast cancer than African-American women.

Dense breast tissue
Have dense breast tissue

Women with dense breast tissue have a higher risk for breast cancer. Dense breast tissue is less fatty and more glandular and appears white on X-Rays, making it difficult to spot tumors.

Estrogen or hormone therapy
Have undergone estrogen or hormone therapy

The greater a woman’s exposure to estrogen, the greater the chance she has to develop breast cancer.

Menstruating prior to 12 or after 55
Have begun menstruating prior to age 12 or have stopped menstruating after age 55

Women who started having menstrual cycles before age 12 or stopped menstruating after age 55 are at an increased risk for breast cancer.

Women pregnant after 30
Have had a child after age 30 or have never had a child

Women who had a child after age 30 or who have never had children have an increased risk for breast cancer.

overweight
Are overweight

Obesity may increase a woman’s estrogen levels, making her more likely to develop breast cancer.

Regular alcohol consumption
Consume alcohol regularly

Regular alcohol consumption – more than two drinks a day – increases a woman’s risk for breast cancer.

High red meat or animal fat diet
Have a diet high in red meats, processed meats, and animal fats

Women who eat unhealthy diets high in red meats, processed meats, and animal fats may be at an increased risk for breast cancer.

Taken DES medication
Have taken DES

Women who took diethylstilbestrol (DES) in the 1940s-1960s to prevent miscarriage may have a higher risk for breast cancer after age 40.

Women with a higher risk

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Women with a higher risk

For women at higher risk, more frequent screenings can be recommended at an earlier age. Your doctor will decide which diagnostic exam is right for you, based on your personal risk assessment and/or your genetic testing results.

  • Clinical Breast Examination (CBE): Clinical breast examinations (CBEs) can be recommended every 3-6 months, as early as age 20-25, depending on the risk factor.
  • Mammogram: Annual mammograms can be recommended as early as age 25-30, depending on the specific risk factor(s).
  • Breast MRI (Magnetic Resonance Imaging): Annual breast MRI can be recommended as early as age 25-30, depending on the specific risk factor(s).

Women may have a higher risk if they:

breast cancer history

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Have had breast cancer in the past

Women who have previously had breast cancer, endometrial cancer, ovarian cancer or colon cancer are at higher risk for breast cancer.

Genomic testing

Have a family history of breast cancer

Women with a close relative (mother, sister or daughter) who has had breast cancer are two to three times more likely to get the disease. In rare cases, family history can be related to hereditary cancer and in that case the risk may be tenfold.

history of lobular carcinoma

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Have a personal history of lobular carcinoma in situ (LCIS) or atypical hyperplasia

Lobular carcinoma in situ (LCIS): LCIS is a non-invasive abnormality confined to the milk-producing lobules of the breast. It is not cancer, but is a risk factor for the development of cancer in the future.

history of atypical hyperplasia

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Have Atypical hyperplasia

Hyperplasia is an overgrowth of the cells in the breast. Hyperplasia may be “usual” or “atypical”. In usual hyperplasia, the excess cells look normal under a microscope. In atypical hyperplasia, the excess cells look abnormal. Women with atypical hyperplasia should monitor their condition closely with routine mammograms and clinical breast examinations.

history of radiation
Have a history of radiation therapy to the chest before age 30

Women who were treated with radiation therapy to the chest during childhood or adolescence have a much greater risk for developing breast cancer. The beams of radiation can damage healthy cells in the body and cause cancer to develop years later. Women who received high-dose mantle field radiation for Hodgkin Lymphoma have the greatest risk.

inherited mutation in BRCA1 or BRCA2
Have an inherited mutation in the BRCA1 or BRCA2 gene

An inherited mutation in the BRCA1 or BRCA2 gene can greatly increase a woman’s risk of developing breast cancer and ovarian cancer. Women with a mutation in one of these genes may have up to a 40% to 65% risk of developing breast cancer in their lifetime and are more likely to develop breast cancer at a young age. Women should talk to a doctor about the benefits and risks of genetic testing and counseling.

Genetic history
Have a history of other genetic syndromes

Other genetic syndromes such as Li-Fraumeni syndrome, Cowden syndrome and Bannayan-Riley-Ruvalcaba syndrome are associated with genetic mutations in genes such as p53, PTEN, ATM, CHEK2 and PALB2. These conditions can increase a woman’s risk for breast cancer and other cancers. However, these mutations are less common and less dangerous than BRCA mutations.

Talk to your doctor

Talking to doctor

There are different well-respected guidelines for breast cancer screening that vary slightly from one another in terms of which tests to use, when to start testing, and how often to test. In general, screening guidelines for breast cancer are based on a woman’s age, risk factors for breast cancer, and personal preferences. Talk to a doctor if you have any questions about whether screening is right for you.