Risk and Prevention
What can I do to lower my risk of breast cancer?
Exercising, maintaining a healthy weight, not smoking, and lessening alcohol are important for your overall health. In addition, these things can have a potential impact on lowering your risk of breast cancer. But tamoxifen and raloxifene (Evista) will cut your risk at least in half–much more in some cases. Your provider can calculate your specific risk and advise you whether the benefits of preventive medications outweigh the costs and the risks of side effects in your specific case. They usually will if your 5-year risk is more than about 2%.
Do I have a breast cancer gene?
In general, genetic abnormalities leading to an increased risk for developing breast cancer, are extraordinarily rare. Of all women diagnosed with breast cancer, only 5%-7% of those can be attributed to an underlying genetic abnormality. Typically, these women themselves have or have multiple family members with premenopausal diagnoses of breast and/or ovarian cancer. In addition, the BRCA abnormalities may manifest as early onset prostate cancer, pancreatic cancer, or melanoma. Breast surgeons and genetic counselors can determine your personal risk and advise whether it is worth pursuing genetic testing in your case.
Guidelines from the National Comprehensive Cancer Network (NCCN) suggest that women undergo testing if they:
Should I find out if my breast tissue is dense?
- Have a worrisome family history like that described above.
- Are diagnosed with any type of breast cancer at less than 50 years of age.
- Are diagnosed with a breast cancer that does not possess the estrogen, progesterone and HER2 receptors (triple negative breast cancer) at less than 60 years of age.
- Are of Ashkenazi Jewish heritage. (It is well documented that women of this ethnicity have a 6 times increased risk for carrying a BRCA mutation.)
- Have had breast cancer in both breasts or have had two different cancers
Every time you have a mammogram, your breast density is referred to in the radiologist's mammogram interpretation. There are four categories of breast density, from fatty replaced breast tissue (category 1) to extremely dense breast tissue (category 4). Dense breast tissue can make detecting breast cancer more challenging. Dense breast tissue also slightly increases the risk of developing breast cancer. For women with dense breast tissue, additional breast imaging, such as whole breast screening ultrasound, may be suggested. Your physician or healthcare provider can discuss your breast tissue density and what it means for you.
How should I screen for breast cancer if my breast tissue is dense?
The American Cancer Society and National Comprehensive Cancer Network (NCCN) recommend that women with very dense breast tissue speak with their healthcare providers about the risks and benefits of combining a screening mammogram with a breast MRI. A mammogram is the only screening imaging method for breast cancer shown to decrease mortality. However, in select high-risk populations (such as women whose lifetime risk of developing breast cancer exceeds 20% or women with a genetic predisposition to breast cancer) supplemental screening with breast MRI or ultrasound can be beneficial. MRI does have a high sensitivity of detecting breast cancers, but it is also expensive and requires IV contrast dye. It also has not been shown to reduce breast cancer mortality rates. Ultrasound is noninvasive but is dependent on who performs the exam, which can often lead to “false alarms” requiring further evaluation. Therefore, screening for dense breast tissue should consist of a clinical breast exam and screening mammogram, followed by a discussion with your healthcare provider to see if any other imaging studies are recommended for you.
Do certain breast conditions, such as mastitis, increase chances breast cancer?
Mastitis does not predispose or make you susceptible to breast cancer. However, other benign conditions are considered indicators of an increased risk for breast cancer. These are usually diagnosed on a biopsy performed for a different reason. Some of these conditions include atypical hyperplasia and lobular carcinoma in situ. If you have had such a diagnosis, you should discuss risk-reducing options with your provider.
Why do I need a surgical biopsy if my core biopsy did not show cancer?
A core biopsy can be very helpful in determining the type of tissue present in a lump or abnormality on breast imaging. However, if the suspicion is high enough and there is concern that the results of the core biopsy do not match the findings on physical exam or breast imaging (called a discordant core biopsy result), your surgeon may recommend that the entire area of concern be removed to make sure that there is no cancer. Also, some core biopsy samples may show abnormal cells, called atypia. If a core biopsy shows atypia, it may indicate the presence of cancer in nearby tissue. A larger sampling of tissue will be recommended. A careful discussion with your surgeon will help you determine your need for a surgical biopsy.