By Lisa D. Curcio, MD, Breast Surgery, Nuvance Health
Average risk of breast cancer. High risk of breast cancer. How to lower your risk of breast cancer. What does this all mean, actually?
Finding out your breast cancer risk can help you manage it and give you more control over your health.
Here’s what you need to know about risk assessments for breast cancer and what you can do with the information.
Who is at average risk of developing breast cancer?
Breast cancer is the second most common cancer among women in the United States, besides some skin cancers. Women are at 13% risk of developing breast cancer just by being a woman. That means 1 in 8 women will get breast cancer in their lifetime.
Men can also get breast cancer, but it is less common. For men, the lifetime risk of getting breast cancer is about 1 in 833. Learn more about breast cancer risk in men.
Related content: Who is at risk for breast cancer?
Who may be at high risk of developing breast cancer?
Genetics and reproductive health
Genetics, family and personal health history, and lifestyle can influence breast cancer risk.
Genetics is what you are born with. While you can’t change your genetic predisposition to breast cancer, you can manage it by seeing a breast health specialist for additional surveillance. You can also lower your risk through lifestyle modifications.
During a breast cancer risk assessment, your breast health specialist or genetic counselor will ask you for a family health history. You may be at higher-than-average risk if you have a strong family history of breast cancer, ovarian cancer, or BRCA1 or BRCA2 gene mutations.
Related content: Genetic counseling for breast cancer
Your doctor or genetic counselor will also ask you about your history of pre-cancerous conditions such as atypical hyperplasia because they can increase breast cancer risk.
Your reproductive health can also influence breast cancer risk, including when you started and stopped your menstrual cycle, and if or when you were pregnant or breastfeeding.
A sedentary or inactive lifestyle can increase breast cancer risk. Many studies show that regular exercise can lower breast cancer risk. The American Cancer Society recommends getting about 2.5 to 5 hours of moderate physical activity a week, or about 1 to 2 hours of vigorous activity a week. Find something you love doing so you can stay active, whether walking or playing pickleball — even dancing in your living room counts!
We do know that eating a healthy diet can help manage your breast cancer risk. A plant-based diet can fuel your body so you can stay active and maintain a healthy body weight.
Aim to eat colorful fruits and vegetables and whole grains most of the time. Avoid foods with added sugars, saturated and trans fats, and foods that are processed and high in sodium. Animal protein is OK; just aim to eat more lean meat such as chicken and turkey rather than red meat, which includes beef and pork.
Related content: Nutrition and breast cancer risk
Speaking of healthy body weight, studies have linked being overweight or obese with increased cancer risk. According to the U.S. Centers for Disease Control and Prevention (CDC), being overweight or obese can cause changes in the body that can lead to cancer. These changes include long-term inflammation and higher levels of insulin, which can lead to Type 2 diabetes. We also know chronic inflammation and Type 2 diabetes can increase breast cancer risk.
Related content: Foods that help fight inflammation
Alcohol and smoking
Research shows drinking alcohol, including beer, wine and liquor, increases breast cancer risk. Alcohol can increase estrogen and other hormone levels associated with hormone-receptor-positive (HR+) or hormone-positive breast cancer. Alcohol can also damage the DNA in cells, which may increase breast cancer risk. If you drink alcohol, the CDC recommends not drinking more than 1 drink a day for women and 2 drinks a day for men.
Related content: Managing stress without alcohol — exploring healthier alternatives
Mostly everyone knows smoking is detrimental to your overall health. What some people may not know is smoking increases the risk for many types of cancer, not just lung cancer — including breast cancer. Cigarette smoke contains toxins, including cancer-causing chemicals.
We know it can be difficult to quit smoking, and there are resources to help. Speak with your primary care provider if you need help to quit smoking. You can also call 1-800-Quit-Now (1-800-784-8669) to find your state’s Smoking Cessation Hotline and speak with someone who can offer advice.
Why does having dense breasts increase breast cancer risk?
If you have had a mammogram before, your radiologist or doctor might have said you have dense breasts. Breasts contain glandular, fibrous connective and fatty tissues. Dense breasts increase breast cancer risk because they have more glandular and fibrous connective tissues and less fatty tissue. High-density breasts also make it harder for doctors to see cancer on mammograms.
If you have dense breasts, your doctor may recommend you have screening mammograms plus breast ultrasounds. Ultrasounds produce images that offer a closer look at breast tissue.
What are models to evaluate breast cancer risk?
There are several different breast cancer risk models. We recommend working with a doctor or genetic counselor who uses a model that calculates risk based on the following criteria.
Age: Breast cancer risk increases with age.
Personal health history: A risk assessment should consider your breast density and history of ovarian cancer and benign breast diseases such as hyperplasia, atypical hyperplasia and lobular carcinoma in situ.
Multigenerational family health history: A comprehensive risk assessment should account for first-degree relatives (parents, siblings and children) with breast or ovarian cancer and your entire family’s history of cancer.
Inherited gene mutation. BRCA1 or BRCA2 gene mutations increase hereditary breast cancer risk. You will need genetic testing to determine if you have any gene mutations that might increase cancer risk.
Ethnicity: In particular, Ashkenazi Jewish women have a higher risk for breast cancer.
Body mass index: BMI is one measure of body fat based on height and weight and may indicate if you are overweight or obese. However, your doctor should also consider your overall health and bone density and muscle mass to help determine a healthy weight for you.
Reproductive health: Never having a full-term pregnancy, having your first child after age 30 and not breastfeeding may increase breast cancer risk, as well as starting your period before age 12 and going through menopause after age 55. All these increase lifetime exposure to estrogen, which may increase breast cancer risk.
Taking hormones. Using hormonal contraception (birth control) and hormone replacement therapy (HRT) may increase breast cancer risk depending on how much estrogen is in them and how long you use them.
Why should I know my breast cancer risk?
No one can totally control getting breast cancer or not. But if you are at higher-than-average risk of developing breast cancer, there are things you can do to lower your risk.
Your breast health risk assessment will likely start with your primary care provider or gynecologist. Tell them about your family and personal health history and lifestyle. They may recommend seeing a breast health specialist or genetic counselor to determine if you have an inherited risk for cancer.
You will also benefit from establishing a relationship with a breast health specialist for routine clinical breast exams and screenings.
If your risk of developing breast cancer is average, that means you do not have known factors that may increase your risk. But it’s still very important to take care of your breasts! Women who are at average risk of developing breast cancer should start annual screening mammograms at age 40. Screening mammograms can save lives because they can detect early-stage breast cancer.
Early detection is the best protection against breast cancer. Your doctor may recommend starting screening mammograms earlier if your breast cancer risk is high. If you are high risk, they may also recommend additional screenings, including an ultrasound or MRI. There are also other interventions to help manage your risk, including medications.
The bottom line: Stats, studies and models can help you understand your breast cancer risk. But what’s most important is what you do with the information. It’s also important to know that not everyone at high risk will get breast cancer, especially if you take steps to lower your risk. Your health matters and taking steps to lower breast cancer risk can benefit your overall well-being.