Breast cancer is the most frequently diagnosed cancer in U.S. women, excluding cancers of the skin, and is the second leading cause of cancer deaths in the U.S., exceeded only by lung cancer.1,2 Women born today have about a 1 in 8 chance of developing breast cancer at some point during their lives.1
Women with certain risk factors will have different screening protocols than those designed for average risk women, which may include adjunctive screening with MRI, referral to a genetic counselor and/or earlier or more frequent mammograms.11,13-16 This includes women who have:
A history of therapeutic radiation to the chest as a child or young adult17, 18
Certain genetic mutations16, 19-24
A first degree relative with certain genetic mutations14, 16, 25
A family history of breast or other BRCA-related cancer (such as ovarian cancer)23, 24
A personal history of breast cancer (invasive or in situ)26-32
A personal history of lobular carcinoma in situ (LCIS)33-36
A personal history of atypical hyperlasia (ADH or ALH)37, 38
A lifetime risk of breast cancer of 20% or higher or a five-year risk of 1.67% or higher11, 25
Other factors also increase a woman's risk of developing breast cancer but do not necessarily change her screening protocol. These factors include:
Age: The incidence of breast cancer rises with age.39
Sex: Breast cancer is 100 times more common in women than men.2
Benign Breast Disease: The risk of breast cancer is higher in women diagnosed with proliferative lesions and may also be slightly increased for women with non-proliferative lesions.37, 38
Breast Density: Women with mammographically dense breasts are at higher risk of breast cancer than those with fatty breasts. 40-42 Dense breast tissue can also make it harder to detect cancer with mammography. 43, 44
Reproductive History: Some reproductive factors increase risk, including early age at menarche, later age at menopause, nulliparity (never having children), and giving birth for the first time at an older age.45-49
Hormone Therapy After Menopause (also called hormone replacement therapy or menopausal hormone therapy) : The use of hormone replacement therapy that contains both estrogen and progestin increases the risk of breast cancer, with risk increasing with duration.50-56
Body Mass Index (BMI): In post-menopausal women, the risk of breast cancer is higher in women with high BMI and in women who gain weight in adulthood.57-67 In contrast, high BMI is associated with lower risk of breast cancer in pre-menopausal women.57, 62, 64, 67, 68
Height: Women of tall stature are at a slightly increased risk of breast cancer.65, 69-72
Alcohol: Alcohol consumption increases a woman's risk of breast cancer; the level of risk is dose-dependent.73-82
It is estimated that between 29%-33% of breast cancers in the United States could be prevented by changes in lifestyle. Among women whose risk is elevated, it is estimated that as many as 50% of breast cancer cases could be eliminated through the use of preventive medications. 83-85
Maintaining a Healthy BMI: For post-menopausal women, weight reduction may reduce the risk of breast cancer.60, 86
Breast Feeding: For women who have children, breast feeding protects against breast cancer, with risk decreasing as duration of breastfeeding increases.46, 62, 87-89
Exercise: Women who engage in regular physical activity may reduce their lifetime risk of breast cancer by as much as 25%.90-95
Chemoprevention: For women at higher risk of breast cancer, the use of selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs) significantly reduces the risk of invasive estrogen receptor- positive breast cancer.96-98 Several major organizations recommend that chemoprevention be discussed as an option for women 35 and older who are at increased risk.99-101
For information on cancer screening services for medically underserved women:
Breast and cervical cancer screening services are available to medically underserved women living in the United States through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). This national program is sponsored by the Centers for Disease Control and Prevention (CDC) and provides access to free or low-cost screening for eligible women. In California, the Every Woman Counts (EWC) program assists low income, uninsured, underserved women in obtaining high quality breast and cervical cancer screening and follow-up services. The program is funded through the California Department of Health Care Services (DHCS), from federal grant monies, and State of California funds: The Breast Cancer Control Account (BCCA), Proposition 99, and the General Fund.
Women who would like to find an EWC provider in their area may call the 24-hour automated EWC consumer line at 1-800-511-2300 or use the online provider locator.
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