Risk Assessment

Overview:

• Every woman is at risk for developing breast cancer and a woman’s risk of developing breast cancer increases with age (Ref. 1).
• 1 in 8 women, will develop breast cancer during their lifetime and I in 3 of these women will develop metastatic disease (Ref. 2).
• Breast cancer mortality rates have stopped declining in U.S. women under age 40 (Ref. 3).

Major Risk factors:

1. Family History
   • Women who have a first degree relative (mother, sister, daughter) with breast cancer have double the risk of developing breast cancer as compared to average risk women (Ref. 4).
   • If a woman has two first degree relatives diagnosed with breast cancer, her risk of developing is five times that of an average risk woman.
   • Having a breast cancer on the paternal side of the family is now a well-recognized risk factor for developing breast cancer. However, determining the magnitude of the risk can be challenging because males can be “silent carriers” of high-risk mutations without developing a breast cancer. For example, we had a woman whose father had no history of breast cancer and thus assumed that the paternal side of the family was negative for breast cancer. It was later determined that her grandfather had breast cancer. This delayed information led to major modifications in her treatment plan.
2. Breast density
   • Breast density is not just a major risk factor for developing breast cancer, it also makes early detection of small breast cancers more challenging. (Breast Density).
3. Exposure to Chest wall Radiation
   • Exposure to chest wall radiation in young women such as women with a personal history of radiation treatment for Hodgkin’s Disease are at high-risk of developing breast cancer at a young age.
   • A recent study concluded that women who received chest radiation to treat a childhood cancer have a 40% increased risk of developing breast cancer (Ref. 5).
   • Young women with a history of scoliosis and who receive multiple chest x-rays at an early age are also at high-risk of developing early onset breast cancer (Ref. 6).
   • Women with a history of chest wall radiation at a young age should be followed in a high-risk clinic.
4. High-risk biopsies: Atypia
   • Women with a history of a breast biopsy showing atypia or Lobular Carcinoma In Situ (LCIS) are at a higher risk for developing a future breast cancer (Ref. 7).
5. Reproductive history
   • Menstrual periods before the age of 12 or menopause after age 50 increase a woman’s risk of developing breast cancer (Ref. 8).
   • First pregnancy after age 35.
   • Birth control pills: Studies show a small increase in the risk of developing breast cancer in women who have taken birth control pills (Ref. 9).
   • Also, there is an increase in cervical cancer risk in women who have taken the “pill” for more than 10 years. After stopping birth control pills, cervical cancer risk returns to baseline.
6. Hormone Replacement Therapy
   • Studies of the risks of long-term estrogen-only replacement therapy are mixed. Some studies have indicated that long-term estrogen replacement therapy may increase the risk of developing breast cancer, but more recent reports suggest the risk is limited to women who have taken it for more than 10 Years (Ref. 10).
   • A recent study indicates that long-term estrogen only treatment lowers breast cancer risk by 20% (Ref. 11). The same study concluded that estrogen plus progesterone increases breast cancer risk by about 75%, even with short term use.
7. Being overweight
   • Having a body mass Index (BMI) over 25 increases a woman’s risk of being diagnosed with breast cancer (Ref. 12).
   • Obesity also increases a breast cancer survivor’s risk of developing a recurrence (Ref. 13).
   • A healthy diet “may” decrease your risk of developing breast cancer. The Mediterranean diet which includes extra-virgin olive oil and nuts “might” reduce breast cancer risk according to the Mayo Clinic (Ref. 14). They also recommend a plant-based diet including lots of fruits and vegetables.
8. Alcohol
   • Women who have three alcoholic drinks per week have a 15% higher risk of breast cancer. Experts estimate that the risk of breast cancer goes up another 10% for each additional drink (Ref. 15).
9. Tobacco
   • A recent study concluded that women who had previously smoked were 14% more likely to develop breast cancer than those who had never smoked (Ref. 16).
     Women who started smoking before age 17 were at higher risk of developing breast cancer than women who started after age 17. The authors also found that smoking for more than 10 years increased the risk of developing breast cancer by 21%. Smoking cessation was associated with only a small reduction in risk.
10. Exposure to toxins
    • Multiple recent studies have identified hundreds of environmental toxins that are associated with an increased risk of developing breast cancer (Ref. 17). The conclusions of these studies are hotly debated among environmentalists and the industrial chemical industries.
    • The one toxin studied the most over the past several decades is DDT (Ref. 18) DDT exposure was widespread during World War II. Like most toxins, there is evidence that the earlier the age of exposure, the higher the level of exposure, the greater the risk.
    • There is now evidence that pregnant women with a history of DDT exposure pass the risk on to their daughters (Ref. 19). Thus, a mother’s exposure to DDT increases the risk of developing breast cancer in her daughter. There is concern that other toxins may subject the daughter to an increased risk, but the current data is insufficient to confirm this assumption.

Conclusion:

Every woman is at risk for developing breast cancer. Every woman should be aware of any personal risk factors try to reduce their personal risk of developing breast cancer. Finally, all women must participate in aggressive screening as outlined above.

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