For the most part, I would say that women would agree that screening for breast cancer with annual mammography is very important. However, mammography is effective at detecting breast cancer but does nothing for PREVENTION. In fact, do you truly understand what YOUR personal risk of developing breast cancer is?
Breast Cancer Risk Factors
In the general population, 12% of women, or 1 in 8, will develop breast cancer over the course of a lifetime. However, in our practice, we see many women who have a much higher lifetime risk of developing breast cancer – 20 – 30% lifetime risk or greater. How do we identify these women and is YOUR risk of developing breast cancer elevated?
70% of breast cancer cases are due to sporadic causes which means that only 30% is attributable to genetic factors. Of the cases that are genetic in origin, 5-10% are related to the breast cancer genes (BRCA 1 and 2), and 10-15% are seen in family clusters. Factors that increase the risk of breast cancer include early puberty (before age 12) and late menopause (after age 55). Women who go through menopause after age 55, have a two-fold increase in breast cancer compared to women who enter menopause younger than age 45. Women who have never been pregnant and women who are older at the time of their first pregnancy both share an increased risk of developing breast cancer. Women who have their first birth older than age 30 are at twice the risk of developing breast cancer than women who have their first birth at age 20. The risk is highest for women who have their first child after age 35.
Risk Factor: Dense Breasts
Another risk factor for breast cancer is having dense breasts. Dense breasts have less fatty tissue, and the degree of tissue density correlates directly with the increased risk of mammographic failures in detecting cancer. Women with heterogeneously dense and extremely dense breast tissue should be offered second imaging modalities like breast ultrasound as a means to increase cancer detection over standard mammography alone. In addition, women with dense breasts should choose 3D mammography or tomosynthesis which has a better detection rate with less likelihood of “missing” cancer due to its enhanced visualization of dense tissue. If you are unsure if your breast tissue is dense or not, I encourage you to educate yourself and ask your provider to help you interpret your most recent mammogram report.
What Factors Play a Role in Breast Cancer Risk?
Lastly, lifestyle factors play a significant role in breast cancer risk. In fact, 30% of breast cancers can be attributable to poor lifestyle and could thus be prevented. Obesity, lack of exercise, alcohol intake, and eating a Standard American Diet lacking adequate intake of vegetables and fruits and high in sugar and unhealthy fats all increase the risk of developing breast cancer. Obesity increases the risk of postmenopausal breast cancer and increases the risk of relapse after breast cancer diagnosis. It also decreases the response to chemotherapy and decreases survival. Alcohol intake increases the risk of breast cancer, and the risk increases with just three drinks per week. Binge drinking increases the risk, and the risk is associated with cumulative alcohol intake over a lifetime.
What Genetic Testing is available at the Couri Center
So, back to the original question – how do we identify women at higher risk of developing breast cancer? Knowing each woman’s individual risk of breast cancer is very important and drives decision making to help lower or modify that risk. At the Couri Center, we offer genetic testing for hereditary breast and ovarian cancer with the Myriad myRisk®Hereditary Cancer Panel. This cancer test is a 29-gene panel that identifies an elevated risk for eight hereditary cancers including breast, ovarian, uterine, colorectal, pancreatic, gastric, prostate, and melanoma. In addition, the testing also includes a breast cancer riskScore™which uses clinical risk factors and genetic markers to provide women with their remaining lifetime and 5-year risk for developing breast cancer. It is personalized, precision medicine at its finest.
How Can I Prevent Cancers?
Knowing one’s personal risk of breast cancer is powerful because we can use that information to potentially change the trajectory of cancer. We can provide education about ways to lower personal risk as well as make recommendations for additional screening modalities to aid in detecting cancer or pre-cancer at their earliest stages. In fact, we have developed a personalized, lifestyle-based program called Prevent, which uses individualized testing and other innovative tools to help women lower their risk of developing cancer. Stay tuned, as more information about Prevent will be showcased in the January/February 2019 newsletter. You deserve the very best in personalized medicine. Knowledge is power – rest assured that we are here to empower you to know your risk and use it to outsmart cancer.
To Your Health,
Dr. Couri