Prevention and Risk Assessment
An individual’s risk for developing breast cancer is influenced by many factors. The strongest risk factor for developing breast cancer is being born female, and the second strongest risk factor is becoming older. The majority of breast cancers are diagnosed in women greater than age 60, but breast cancer can occur at any age. The next risk factor to consider is family history (breast cancer diagnosed in a first degree relative: mother, sister, or daughter). The vast majority of breast cancers occur in women with no family history (80%). The age at which the relative was diagnosed with her cancer is another important factor to consider.Having had multiple breast biopsies in the past is another risk factor, and if the pathology on those biopsies show a finding called atypia, the risk is felt to be increased further. Race is also a risk factor, as Caucasians are more likely to get breast cancer than African Americans or Asians. African Americans who develop breast cancer, however, are more likely to have more advanced cancer than other ethnic groups.
There are a number of other factors that are felt to influence the risk of getting breast cancer which are harder to quantify in terms of their contribution to the risk. Estrogen exposure has many different facets. Young age at the time of the first menstrual period (< age 11), never having given birth, having the first child over the age of 30 are risks related to estrogen exposure. Another risk factor is long term postmenopausal hormone use (>10 years). It is important to remember that estrogen does not cause a breast cancer to be formed, but it can promote the growth and spread of a cancer that does form.
Certain individuals are at risk to develop breast cancer because of an inherited genetic alteration. The alterations identified so far are called BRCA-1 and BRCA-2. These individuals only make up a small portion of those women who will develop breast cancer, but those who do have the mutation can have as high as risk as 80-90%.
The above mentioned factors are all considered in evaluating a woman’s risk for getting breast cancer. One method of calculating risk that is commonly used by breast care providers is called the Gail Risk Assessment Tool . The result of this calculation can help to decide if any breast cancer prevention treatments are appropriate.
As all women bear some risk for getting breast cancer, it seems reasonable for each one to attempt to modify those factors that are under her control. Other risk factors are toxins such as tobacco and excessive alcohol consumption. Obesity, a diet high in saturated fats and lack of exercise have also been shown to increase a woman’s risk for developing breast cancer. The incidence of breast cancer in the United States has increased to 1 in 8 women from 1 in 15 women in the last 20 years. Modifications in our lifestyle during this period of time have certainly contributed to this increase, so taking proactive steps to counteract this just makes sense.
Some individuals have a high enough risk for developing breast cancer that some medical interventions may be recommended. Some of these women may benefit from the use of the drug Tamoxifen, which has been shown to reduce the development of cancer in these high risk women by 50%. In certain others, their risk of developing cancer is so high that consideration for prophylactic surgery is appropriate. These recommendations can be made only with extensive knowledge of the woman and her history, and lengthy discussion is necessary among all of the patient’s health care team before such a recommendation is made.
