What You Might Not Know About Your Breast Cancer Risk

Knowing your risk profile means having more options for prevention and early detection.

You’ve probably seen this statistic: 1 in 8 women will be diagnosed with breast cancer. I used to think to myself as I read that, “What does that mean for me, exactly?”

When I was diagnosed with early-stage breast cancer, I started thinking even more about that statistic. I also wondered if my diagnosis would change things for any of my family members (spoiler: yes!). And then I realized the question I should have been asking — the question every woman should be asking — is: “What is my personal lifetime risk of developing breast cancer?”

That 1 in 8 statistic only tells you the average risk of breast cancer. But many women have a higher risk and may need to start screening earlier, be screened more often or have different types of screening. Those at very high risk may need to take even more steps to reduce the likelihood of breast cancer.

Many women are scared to dive into their breast cancer risks, preferring to stay in the dark. I think that’s a huge mistake.

This is information you can act on to reduce your risk or to increase the likelihood of early detection.

With that in mind, consider some questions you might have about your own risk profile.

What does it mean to have an increased risk of breast cancer?

A woman’s individual breast cancer risk is based on a combination of health, family and genetic characteristics, plus factors such as weight, alcohol consumption, physical activity and diet. This risk is described as a “lifetime” risk — the risk that, at some point in your life, you will be diagnosed with breast cancer.

Clinicians classify women’s breast cancer risk into three categories:

• Average risk: less than 15% likelihood
• Moderate/intermediate risk: 15% up to just under 20% likelihood
• High risk: greater than 20% likelihood

Around half of all breast cancers occur in women who are at average risk. That’s why every woman age 40 and older needs an annual screening — usually a mammogram.

What can I do about an above-average breast cancer risk?

While an annual mammogram is the right approach for many women, those who are at moderate or high risk may need a different plan, says Alejandra Perez, M.D., who leads Sylvester Comprehensive Cancer Center’s Breast Cancer Assessment Risk Evaluation (CARE) Clinic.

The CARE Clinic works with women at increased risk for breast cancer, creating personalized screening plans and helping them make lifestyle changes that can reduce their cancer risk. “There are a lot of things you can do — from lifestyle interventions to risk-reducing surgery to medications,” Dr. Perez explains.

If you and your care provider determine that you’re at above-average risk for breast cancer, there are two types of changes you or your provider might make:

Adjust your breast cancer screening plan to increase the likelihood of early detection by:

• Starting your annual imaging screenings before the age of 40
• Increasing the frequency of your screenings from yearly to twice a year
• Adding an ultrasound to your annual mammogram if you have dense breast tissue
• Adding annual breast MRI, staggering screenings so it’s done six months after your annual mammogram
• Obtaining an IV-contrast-enhanced mammogram, which can lead to more precise screening

Lower your likelihood of getting breast cancer by:

• Placing higher importance on regular exercise
• Working with a dietitian to eat more cancer-fighting foods and fewer that can increase your cancer risk
• Reducing or eliminating alcohol consumption and/or smoking
• Prioritizing reducing body fat and increasing muscle mass
• Taking an estrogen-modulating medication, such as tamoxifen, for several years
• Choosing risk-reducing surgery, such as a mastectomy

How do I learn about my breast cancer risk profile?

To understand your own breast cancer risks, ideally, ask your primary care or gynecologic health care provider. “Have that conversation,” Dr. Perez says. “Just ask a simple question: ‘What is my lifetime risk of developing breast cancer?'”

Start the conversation now, no matter your age. Yes, even if you’re barely into your 20s. “We’re seeing an increased incidence in breast cancer cases in women under 40,” Dr. Perez says. “I’m sure women in their 20s are not thinking about it, but it’s always a good opportunity to find out.”

In fact, the American College of Radiology and the Society of Breast Imaging recommend that every woman have a formal breast cancer risk assessment by age 25. “Younger women need early assessment to understand their risk,” said Jose Net, M.D., Sylvester’s director of breast imaging services. “This will empower young women to better understand where they stand in terms of risk for future cancer and to gain awareness of strategies that can potentially impact their mortality.”

You can also take Sylvester’s online breast cancer risk screening questionnaire. It asks six simple questions that help determine whether you might be a candidate for the CARE Clinic. The results could be used to start the conversation with your doctor, or if the website notes that the CARE Clinic might be for you, you can make an appointment for a more detailed risk assessment with a Sylvester nurse practitioner.

What is the No. 1 reason some women have a higher risk of breast cancer?

The No. 1 reason women have a higher risk of breast cancer is simply being female. The No. 2 reason for a higher breast cancer risk is increasing age. After those two risk factors, a family history of breast or ovarian cancer is extremely important. This applies even if you don’t have any known genetic mutations that increase risk, Dr. Perez says.

If a parent, sibling, grandparent, aunt or uncle has been diagnosed with breast or ovarian cancer, tell your health care provider right away. Many clinicians recommend that any woman with such a family history should begin having imaging screenings at least 10 years before the age of diagnosis of a first-degree family member. A first-degree family member is a parent or sibling with whom you share genetics.

In addition, a family history of certain cancers may indicate that you are a candidate for testing for genetic mutations or variants.  If you do have certain genetic mutations, you may be referred to a program such as Sylvester’s Genetic Predisposition Syndrome clinic.

What surprising things in my health history might make me more likely to get breast cancer?

Beyond a family history of breast or ovarian cancer, other factors in your health history can also raise your breast cancer risk:

• A blood relative with melanoma, colorectal, pancreatic, endometrial or uterine cancer
• Periods starting before age 12
• Hitting menopause after age 55
• First pregnancy after age 30 or no pregnancies
• Never having breastfed, or breastfeeding for less than a year
• Dense breasts — and the more dense, the higher the risk
• Having taken diethylstilbestrol (DES), or your mother took it while pregnant with you
• Hormone replacement therapy under certain circumstances
• Past breast biopsies
• Certain benign breast conditions
• Radiation treatment to the chest for the treatment of other cancers

Does ancestry affect my breast cancer risk?

Heritage can affect breast cancer risks. Black women in the U.S. are slightly less likely to develop breast cancer than non-Hispanic white women. But they are more likely to be diagnosed with more aggressive, advanced-stage breast cancer, and to get breast cancer before age 50. Both Black and Hispanic women are more likely to be diagnosed with triple-negative breast cancer, a form that is harder to treat and can be more aggressive.

Ashkenazi Jewish heritage increases a woman’s risk of breast cancer, especially hereditary breast cancers caused by genetic mutations. Many researchers and physicians encourage all women with this background to have genetic testing for cancer risks. I’m Ashkenazi Jewish, I’ve been tested, and I am encouraging all my female relatives to do the same.

What are some lifestyle factors associated with higher breast cancer risk?

Other breast cancer risk factors may be changeable. “In the CARE Clinic, we look at lifestyle; so, obesity, diet, lack of exercise, smoking, and increased alcohol intake,” Dr. Perez says.

Lifestyle factors, she says, that are associated with a higher risk of breast cancer include:

• Nutrition: a diet high in saturated fat and/or lacking in fruit and vegetables (less than 3.5 total cups per day)
• Activity: lack of regular exercise or physical activity
• Body composition: gaining 20 pounds or more after menopause, or having a high body-fat percentage after menopause
• Alcohol intake: more than 16% of breast cancer cases can be attributed to alcohol
• Smoking: any amount of smoking, as well as exposure to secondhand smoke

CARE Clinic participants work with health coaches to craft diet and exercise plans and to address smoking or alcohol intake. But Dr. Perez points out that any woman will benefit from a healthier lifestyle. “We have many studies that have shown the benefits [of] maintaining your weight, exercising every day, no smoking, low alcohol intake,” she explained. “Those are all modifiable risk factors.”

Know your breast cancer risk — change your life.

The bottom line: Every woman should know her breast cancer risk and have a personalized breast cancer screening plan. Personally, as a breast cancer survivor with very dense breasts, I have a 3D mammogram and ultrasound together once a year, and a breast MRI six months later.

“My message to women is: ‘Know your risk,'” Dr. Perez says. “Have that conversation with your physician. Be empowered.”

Rochelle Broder-Singer is a journalist, breast cancer survivor and Sylvester Cancer Center patient. She is currently writing a series of articles about the cancer journey from the patient’s perspective.

Medically reviewed by Dr. Perez and Dr. Net.

Tags: Breast cancer awareness, Genetic testing for breast cancer, Personalized screening plans, Rochelle Broder Singer, Sylvester Comprehensive Cancer Center