No matter how complex the science, there’s always a simple starting point when it comes to breast cancer: awareness.
Every woman should know her risk of developing breast cancer.
To begin, it can help to look at the straightforward statistics: A woman’s average lifetime risk of developing breast cancer is 12%—essentially a 1-in-8 chance of facing this disease.
Women at higher risk have more risk factors, which can put their lifetime risk at about 20%, or a 1-in-5 chance.
The screening guidelines for breast cancer change depending on the level of risk.
Women at lower risk can follow the basic screening guidelines. Women at high risk will require additional testing, which can increase the odds of spotting cancer much sooner.
The critical point is that doctors can potentially save a patient’s life if they know the risk factors involved. Prevention and early detection are often the best medicine.
Risk factors for breast cancer include:
- Family history of breast or ovarian cancer
- History of breast biopsies
- Dense breast tissue
- Early onset menses, late onset menopause
- Not having children
- Sedentary lifestyle
- Alcohol use
One of our patients at the Spectrum Health High Risk Breast clinic—I’ll call her Sandy—came to see us after she had a conversation at the Spectrum Health Midlife, Menopause and Sexual Health clinic.
We always ask questions about risk when considering hormone medication for menopause symptoms.
Sandy had a significant family history of breast cancer. She had not had children. She had dense breasts. She was overweight.
I recommended she undergo further evaluation with physician assistant Susanne Pettigrew.
At the High Risk Breast Clinic, the team asked Sandy questions about her habits, family history and prior mammograms.
She had one biopsy of her breast tissue in the past and it came back benign.
This increased her risk even more.
The team evaluated her with a risk calculation called a Tyrer-Cuzick score. It showed a lifetime risk of 45%.
Based on her family history of cancer, we also offered her genetic testing, which showed she had the BRCA2 mutation. This increased her risk of breast cancer to 55 to 85%.
Genetic mutations only account for 5 to 10% of breast cancer, but for those who have it, it’s a significant factor.
Sandy had to consider her options.
She chose to have an MRI because she wasn’t sure if she wanted to undergo a risk reduction mastectomy, which would involve removal of her breast tissue to reduce her risk.
This type of surgery is a big deal. Preparation and knowing what to expect is important.
Sandy’s MRI results showed some suspicious areas. The biopsy showed ductal carcinoma in situ, an early non-invasive breast cancer.
Doctors scheduled her for a bilateral mastectomy and sentinel node biopsy.
The results made her happy that she underwent testing.
She had several spots of carcinoma in both breasts, but no invasive cells and the lymph nodes were clean. She knew she faced high odds of developing invasive breast cancer in the near future.
The testing and early surgery likely saved her life.
At the High Risk Breast clinic, providers talk to women about steps they can take to reduce their risk of breast cancer.
Like what? Maintaining a healthy weight, avoiding tobacco, keeping alcohol to a minimum, staying active with daily exercise and choosing a healthy diet that includes vegetables such as broccoli, Brussels sprouts and cauliflower.
If a woman is at high risk, she might also qualify for medication such as selective estrogen receptor modulators, which would include tamoxifen. This blocks the breast estrogen receptors.
Another approach is an aromatase inhibitor, which blocks estrogen production from pre-hormones made in fat and adrenal glands.
These medications can have significant side effects, but they’re powerful in lowering risk.
Ultimately, we want to put the decision-making power into the hands of each woman. We want all women to know their options.
We also encourage women to take ownership of their results and look at their mammogram report for the BI-RADS score and breast density, information that is required to be on every report.
Breast cancer can afflict anyone, but our goal is to help prevent it.
And if it hasn’t been prevented, we aim to find it early.
Detected early, breast cancer requires less treatment, which allows a woman to get back to her life sooner.