Breast Cancer Risk Factors

Having one gynecologic cancer does not increase your risk of having other types of gynecologic cancer. However, women with a hereditary cancer syndrome are at increased risk of developing a gynecologic cancer. These syndromes include Hereditary Breast and Ovarian Cancer (HBOC) caused by a BRCA mutation as well as Lynch syndrome, also called hereditary nonpolyposis colorectal cancer (HNPCC). Women with HBOC syndrome have markedly elevated risks of breast cancer and ovarian cancer, with a lifetime risk of breast cancer of 50 to 85 percent and a 15 to 40 percent chance of developing ovarian cancer. There is also an increased risk of a second breast cancer diagnosis.

Lynch syndrome is associated with cancer diagnosis at an early age and the development of multiple cancer types, particularly colon and endometrial cancer. Until recently, the majority of attention and research related to Lynch syndrome has focused on colorectal cancer. However, women with Lynch syndrome have a 27 to 71% risk of endometrial cancer, which equals or exceeds their risk of colorectal cancer. This is significantly higher than the 3% risk of endometrial cancer in the general population. In addition, women with Lynch syndrome have a 8-11% risk of ovarian cancer, compared with 1.5% in the general population. The management of endometrial and ovarian cancer risks in women with HBOC or Lynch syndrome includes surveillance, chemoprevention and risk-reducing surgery.

No - many women have "lumpy" breasts which is usually related to the combination of glandular tissue and fatty tissue in the breast, but lumpy is not the same as dense. Breast density refers to the appearance of the breast tissue on imaging, usually mammogram. Dense breast tissue appears more "white" on mammogram, which makes it harder to detect cancer, also usually "white" on mammogram. Younger women naturally have dense breast tissue, but some women still have dense breast tissue even as they get older. Hormone therapy will maintain the dense breast appearance on mammogram.

Women with dense breast tissue on imaging are at higher risk for the future development of breast cancer, and as mammograms may miss more cancers in women with dense breast tissue, additional imaging such as ultrasound or MRI may be helpful.

Breast cysts are completely benign, in other words, not related to breast cancer. Think of them like little "water balloons" in the breast - they develop due to enlargement of an area of the milk duct that fills with fluid. They will often enlarge and may become painful right before the menstrual period, and then often decrease without any intervention. An ultrasound can be used to ensure that a lump is indeed a fluid filled cyst and not a solid tumor. "Simple" cysts, which have a thin wall and no solid growth associated with them can safely be observed, but sometimes fine needle aspiration is recommended if a cyst is large or painful.

It is clear that you may possibly have a predisposition from your family history and yourself that there may be a genetic mutation running in your family. You did not say how old were you when you were diagnosed with your breast cancers. Or what ethic background you have or how old were your relatives when they were first diagnosed with breast cancer.

We all have breast cancer genes in our bodies that are supposed to protect us from breast cancer. People who have the BRCA1 mutation, BRCA2 mutation has a higher risk of getting breast cancer and or ovarian cancer, because the mutation comes from your mother or father and you can receive them at the time of your conception. However, because a person may have the mutation, it does not mean that they will get these cancers in their lifetime.

The BRAC Analysis Rearrangement Test (BART) is an additional level of analysis, which goes beyond DNA sequences of genes. Having this additional test, one has to look at the risk and benefits of this test for you. If you are searching for answers of why breast cancer is prevalent in your family and feel that this test will help resolve issues that are concerning your health, perhaps you should speak to a genetic counselor and your oncologist about this test.

The day I was diagnosed with breast cancer my doctors told me I had to stop taking the pill. When I asked why they told me becasue, "they can cause breast cancer". I went straight home and opened up the pill pack pamphlet folded up in the lid, the one I never read for 15 years, and it says it right there in black and white. I firmly believe that the Rx manufacturers are required to disclose this for a reason and I bet if you talked to enough breast cancer survivors you would learn that this is a huge common denominator. I don't believe it is any coincidence. Dr. Malcolm Pike, epidemiologist at SLoan Kettering Cancer Institute has said he believes the risk increase is closer to 21%, not the "claimed 2%"

I've eliminated everything! This book taught me a ton:
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I removed every cleaning product in my house that was not natural. You can you many natural products to clean your house. One of my favorites is mixing lavender oil with water and spritzing it around as a air freshener.

Next you need to take a look at all of the bath and beauty products that you use everyday. I was shocked to learn that many mainstream face moisturizers contain phyto-estrogens. Many of us have been slathering these on our faces for years. Begin by getting rid of every product that your skin absorbs - lotions, sunscreens, makeup, deodorant (this is an important one) etc. The next step is to clean up your soap, toothpaste, mouthwash - everything that you put on your body but wash off. You can look up specific products on this website:
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I don't buy anything until to look it up on this and other websites. You can't just go to the drugstore and pick up any old brand of beauty aids at this point. It takes some time to clean all of this up but its worth it in the end. You might pay a little more for these more natural products but every extra step with our health counts!

That's a good question, especially with all the information we now have linking breast density to an increased risk of breast cancer. Density refers to relative proportion of fibrous or glandular tissue to fatty tissue in the breast and is most commonly evaluated by appearance of the tissue on mammogram. Dense tissue is not the same as "lumpiness" - a woman can have a lot of lumpy breast tissue but the tissue could be primarily fat. In general, breast density does decrease with age - the normal aging process makes the breast tissue more fatty over time. This results in easier interpretation of mammograms and other imaging studies as women get older as it is harder to "see through" the dense breast tissue on mammogram to identify tumors - this is a major reason why mammograms and even ultrasound and MRI have a harder time detecting breast cancer in younger women.

Breast density is not only influenced by age however. Women that are on hormone replacement therapy will generally continue to have dense breast tissue even after menopause, and some women even without HRT have dense breast tissue - genetics, body weight, diet, activity and other factors probably play a role as well.

It is important to know that your risk of breast cancer is increased if you have dense breast tissue, but the majority of young women DO have dense breast tissue. Density is reported on your mammogram report, but often only on the report that goes to the physician, not the "layperson letter" that you would receive. Several states have either passed legislation or have legislation pending that would require mammogram facilities to inform women of their breast density. It is reasonable to ASK your physician or mammographer about your breast density so that you are informed. Depending on your risk factors, additional testing such as ultrasound and MRI might be recommended, but they are currently not recommended for all women with dense breast tissue. However, this field is changing, so stay tuned!

Dense breast tissue causes 2 problems - one is that it is now known that women with dense breast tissue have a higher rate of developing breast cancer, and the second is that breast cancer is harder to detect in women with dense breast tissue. Mammograms will miss 10-20% of breast cancers, more often in women with dense breast tissue. Ultrasound and MRI examinations can be performed in addition to a mammogram, but no test is 100% sensitive and specific for diagnosing breast cancer. Ultrasound and MRI are also more difficult to interpret in women with dense breast tissue, just like mammograms. MRI in particular also has a relatively high (up to 20%) false positive rate - it will often show things that look suspicious and require further investigation and sometimes biopsy, and the finding then turns out to be normal - these are some of the reasons that MRI is not recommended as a general screening test for all women, but rather is recommended for use in specific situations.

I do feel that women should know their breast density - "lumpiness" on exam is not the same as dense breast tissue. This information is generally included in the formal mammogram report provided to the ordering physician, but is not required to be included in the "lay letter" - the letter that gets sent to the patient (the wording of the reports and the lay letter is regulated by the FDA under the Mammography Quality Standards Act: http://www.fda.gov/Radiation-EmittingProducts/MammographyQualityStandardsActandProgram/Regulations/ucm110906.htm#s9004

Connecticut and Rhode Island have passed legislation requiring that the patient be informed of her breast density, and this is pending in California as well.

There are no uniform recommendations for how to provide increased screening to women with dense breast tissue, but at the very least, make sure that when you get your mammogram, you get a newer digital mammogram, rather than an older, film-screen - you just need to ask the facility and they will let you know. The use of ultrasound and MRI should be discussed with your physician or breast specialist and will take into account your family history and other breast cancer risk factors as well as breast density.

As usual, Dr. Attai you have a great answer. Question: How do we get other states to get on board with legislation requiring the patient to be informed of her breast density? Would you know?

My gynecologist(s)- I've had a number NEVER told me that because I had dense breasts I should have further testing beyond a mammogram, and the ultrasound (my decision to get one) was what picked up the cancer, NOT the mammogram. Obviously this is upsetting because my cancer could have been picked up at stage 1 instead of stage 4. The difference between life and death, literallly.

DES exposure does increase breast cancer risk although study numbers are modest. Monthly breast self-exam and annual screening digital mammography are recommended. If breast are markedly dense (greater than 75 percent) consider tomosynthesis or MRI. Please let me know if you would like additional information on this and I will be happy to provide.

I just wanted to chime in and attest to what Dr. Radford is saying from the patient/anecdotal perspective. I have dense breast tissue. After 12 years of faithfully getting annual film mammograms, my first-ever digital mammogram captured the specks that turned out to be DCIS. And I had a lot of it; two attempts at breast-conserving surgery couldn't get the clean margins my doctors and I were hoping for, so I opted for a mastectomy. I wonder if it might not have been caught sooner if we had used digital mammograms earlier. I had a digital mammogram simply because the radiology group my clinic uses switched to that technology; a nurse told me that they noticed a huge jump in breast cancers after they started using it.

After it was confirmed I had DCIS my oncologist also ordered an MRI to make sure we weren't missing something, and he said he may recommend the occasional MRI going forward (I only had a single mastectomy so we're keeping an eye on the other breast.)

Some of the risk factors that are used to determine if someone is at high risk for breast cancer are:
- if a woman had breast cancer in one breast, there is an increased risk of developing cancer in the other breast unrelated to the first cancer.
- direct family history increases the risk of breast cancer, especially if the family history is a first degree relative.
- having two first-degree relatives who had breast cancer further increases risk
- generationally if the cancer in the family was in both breasts
- if a breast biopsy revealed atypical hyperplasia (lobular or ductal)
- if the woman tested positive for BRCA -1 or BRCA-2 positive
- if the woman's relatives tested BRCA positive
- if your ancestry is Eastern and Central European (Ashkenazi) Jewish
- if ovarian cancer has been in the family
- if a male relative has had breast cancer
- if the person experienced chest radiation between the ages of 10-30

gender
age
race
high fat diet
early onset of mense and late menopause
late or no pregnancies
family history (BRCA-1, BRCA-2)
personal history (already had breast cancer)
dense breast tissue
alcohol consumption
hormone supplementation

Here are a couple of links that go into greater detail:
http://www.mayoclinic.com/health/breast-cancer/DS00328/DSECTION=risk-factors
http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-risk-factors